Wendy Willis

Primary specialty

Licensed Vocational NurseTaxonomy code 164X00000X

License

C202431 Issued in CA

Practice address

4990 Stockton Blvd
Sacramento, CA 95820-5406

Phone

(916) 822-8973

NPI assigned

Feb 3, 2025

Sex

Female

Sole proprietor

Yes

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

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

{
    "created_epoch": "1738540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738540800000",
    "number": "1477367183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3343 RIO LINDA BLVD",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958384353",
            "telephone_number": "916-521-3017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4990 STOCKTON BLVD",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958205406",
            "telephone_number": "916-822-8973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "WENDY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-02-03",
        "last_updated": "2025-02-03",
        "certification_date": "2025-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "CA",
            "license": "C202431",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Roger F Willis III, MA, OPT, SUD
• Sandra E Willis, MD
• Shawnna-Michaella Willis
• Susan Diane Willis, MA
• Wanda F. Willis
• Adam Jordan Wills
• Amity Joy Wills, RBT
• Colin James Wills
• Javonte Wills
• Cynthia Willsmore, LMFT

• Licensed Vocational Nurse in Sacramento, CA
• Providers in Sacramento, CA by specialty
• Licensed Vocational Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2025; 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.