Provider Demographics
NPI:1174702260
Name:WILLIS, LYNN L
Entity type:Individual
Prefix:MS
First Name:LYNN
Middle Name:L
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 1:150 FRANK H OGAWA PLAZA
Mailing Address - Street 2:#4340
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-2092
Mailing Address - Country:US
Mailing Address - Phone:510-238-6132
Mailing Address - Fax:510-238-7696
Practice Address - Street 1:150 FRANK H OGAWA PLAZA
Practice Address - Street 2:#4340
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-2092
Practice Address - Country:US
Practice Address - Phone:510-238-6132
Practice Address - Fax:510-238-7696
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator