Basic Information
| Provider Information | |||||||||
| NPI: | 1003340662 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIS | ||||||||
| FirstName: | ELIZABETH | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4018 KING CHARLES RD | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277075521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192714394 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | N2198 UNC HOSPITALS CB# 7010 | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275997220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199665136 | ||||||||
| FaxNumber: | 9199744873 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2017 | ||||||||
| LastUpdateDate: | 05/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 2020-02126 | NC | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.