La Juana Dell Willis, CFNP
Individual provider Active NPI Nurse Practitioner · Logan, NM
NPI 1306952932 · NPPES record last updated Oct 21, 2019
Key facts
- NPI
- 1306952932
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- CNP00145 (NM)
- Practice address
- 600 Gallegos
Logan, NM 88426-7602 - Phone
- (575) 487-9000
- Fax
- (575) 487-9002
- NPI assigned
- Aug 23, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CNP00145 | NM | MD | Nurse Practitioner |
| R14626 | NM | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| James E. Saltz, Jr. M.D. P.a. | Single Specialty | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner |
363L00000X | CNP00145 | NM | Yes |
| Family Nurse Practitioner | 363LF0000X | R14626 | NM |
Addresses
Primary practice location
600 Gallegos
Logan, NM 88426-7602
Mailing address
PO Box 26666
PHS Provider Enrollment
Albuquerque, NM 87125-6666
Phone (505) 923-6770
Other providers in Logan, NM
- Joyce Elaine Feerer
- Jenna Lindsay Gorman
- Logan Family Practice, LLC
- Sharon Darlene Oliver
- Village of Logan
All providers in Logan, NM · Nurse Practitioner in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 21, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.