Provider Demographics
NPI:1053016048
Name:WILLIS, DENA
Entity type:Individual
Prefix:
First Name:DENA
Middle Name:
Last Name:WILLIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 MILLER AVE
Mailing Address - Street 2:
Mailing Address - City:RANKIN
Mailing Address - State:PA
Mailing Address - Zip Code:15104-1019
Mailing Address - Country:US
Mailing Address - Phone:412-727-7224
Mailing Address - Fax:
Practice Address - Street 1:99 MILLER AVE
Practice Address - Street 2:
Practice Address - City:RANKIN
Practice Address - State:PA
Practice Address - Zip Code:15104-1019
Practice Address - Country:US
Practice Address - Phone:412-727-7224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA68653601163WW0000X, 163WW0101X, 364SH0200X, 364SL0600X, 372500000X, 372600000X, 373H00000X, 3747A0650X, 3747P1801X, 376J00000X, 376K00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
No364SH0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHome Health
No364SL0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistLong-Term Care
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide