Provider Demographics
NPI:1366791782
Name:WILLIS, JILL RENE' (ARNP)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:RENE'
Last Name:WILLIS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 MARTIN LUTHER KING JR WAY
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4238
Mailing Address - Country:US
Mailing Address - Phone:253-792-6680
Mailing Address - Fax:
Practice Address - Street 1:521 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4238
Practice Address - Country:US
Practice Address - Phone:253-792-6680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13467174400000X
WA61226935363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No174400000XOther Service ProvidersSpecialist