Provider Demographics
NPI:1548039563
Name:WILLIS, JANAEA Y (RN)
Entity type:Individual
Prefix:
First Name:JANAEA
Middle Name:Y
Last Name:WILLIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4050 PIEDMONT PKWY
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-9458
Mailing Address - Country:US
Mailing Address - Phone:336-289-8648
Mailing Address - Fax:
Practice Address - Street 1:233 SPRING ST FL 13
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-1522
Practice Address - Country:US
Practice Address - Phone:212-651-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2353053163W00000X
CA95328130163W00000X
DCRN500003327163W00000X
MDR262968163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse