Wade W Willis, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

341789 Issued in NY

Practice address

31 6TH St
Malone, NY 12953-1246

Phone

(518) 319-6825

NPI assigned

Feb 26, 2024

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Citizen Advocates, Inc

  • Mental Illness Community Based Residential Treatment Facility
  • Malone, NY
  • NPI 1477765733
  NPD
• Citizen Advocates, Inc

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Malone, NY
  • NPI 1780619064
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1708905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708905600000",
    "number": "1164288395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "324 COUNTY ROUTE 51 BLDG 1",
            "city": "MALONE",
            "state": "NY",
            "postal_code": "129534502",
            "telephone_number": "518-483-1251",
            "fax_number": "518-483-2242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 6TH ST",
            "city": "MALONE",
            "state": "NY",
            "postal_code": "129531246",
            "telephone_number": "518-319-6825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "WADE",
        "middle_name": "W",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-02-26",
        "last_updated": "2024-02-26",
        "certification_date": "2024-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "341789",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Scott Wheeler, PT
• Lenore White, FPA PROVISIONAL CERT
• Mary Elizabeth White
• Megan Willette, PEER SPECIALIST
• Andrew M Williamson, PRS/PSR
• Edgar Harold Wilson-Bower, PRS/PSR/TCM
• Mackenzie Cara Wilson
• Neil M Winters
• Nathan Harry Witkop, D.C.
• Robert J. Wolff, M.D.

• Licensed Practical Nurse in Malone, NY
• Providers in Malone, NY by specialty
• Licensed Practical Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.