Susan G Willis, ARNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP30000325 Issued in WA

Practice address

2075 Barkley Blvd
Suite 105
Bellingham, WA 98226-6614

Phone

(360) 671-3345

Fax

(360) 650-1354

NPI assigned

Jul 21, 2006

Last updated

Jul 24, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343088000000",
    "number": "1174544761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "709 W ORCHARD DR",
            "address_2": "SUITE #4",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982251766",
            "telephone_number": "360-318-8800",
            "fax_number": "360-318-1085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2075 BARKLEY BLVD",
            "address_2": "SUITE 105",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982266614",
            "telephone_number": "360-671-3345",
            "fax_number": "360-650-1354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "SUSAN",
        "middle_name": "G",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-21",
        "last_updated": "2012-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP30000325",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "US DEPT OF LABOR",
            "identifier": "192942512",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP HEALTH COOPERATIVE",
            "identifier": "423898016",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L & I (CRIME VICTIM)",
            "identifier": "8925053",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L & I (REGULAR)",
            "identifier": "0128742",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUESHIELD",
            "identifier": "25892",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9602970",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "0500013378",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Ann Willis, LMP
• Judith Lynne Willis, MPH RD CD CDCES
• Ramona (Mona) Willis, LMP
• Ryan Willis, ARNP
• Sage Willis, PHD
• Timothy Ronald Willmore, PHARMD
• Kendra Jae Wills
• Jeffrey Charles Willson, LMP
• Kristin Janelle Wilson-Key
• Tami Lynn Wilson-Pen

• Family Nurse Practitioner in Bellingham, WA
• Providers in Bellingham, WA by specialty
• Family Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2012; 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.