Provider Demographics
NPI:1053758540
Name:WILLIS, KATRIANA B
Entity type:Individual
Prefix:
First Name:KATRIANA
Middle Name:B
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 1:885 YORK RD
Mailing Address - Street 2:APT. 22A
Mailing Address - City:WARMINSTER
Mailing Address - State:PA
Mailing Address - Zip Code:18974-2060
Mailing Address - Country:US
Mailing Address - Phone:267-761-7136
Mailing Address - Fax:610-933-4080
Practice Address - Street 1:1288 VALLEY FORGE RD
Practice Address - Street 2:UNIT 69
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-2687
Practice Address - Country:US
Practice Address - Phone:610-933-9483
Practice Address - Fax:610-933-4080
Is Sole Proprietor?:No
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN584933163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse