Mary Grace Willis, LVN
Individual provider Active NPI Licensed Vocational Nurse · Alba, TX
NPI 1629677406 · NPPES record last updated Oct 22, 2020
Key facts
- NPI
- 1629677406
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Vocational Nurse 164X00000X
- License
- 1010685 (TX)
- Practice address
- 232 County Road 2921
Alba, TX 75410-5830 - Phone
- (832) 412-6165
- NPI assigned
- Oct 22, 2020
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1010685 | TX | MD | Licensed Vocational Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Vocational Nurse | 164X00000X | 1010685 | TX | Yes |
Addresses
Primary practice location
232 County Road 2921
Alba, TX 75410-5830
Mailing address
232 County Road 2921
Alba, TX 75410-5830
Phone (832) 412-6165
Other providers in Alba, TX
- Jean Carol Hickman
- Kelly Ann Jewell-Franken
- Jennifer Knuckles
- Micah D Kolb I
- Charlotte Marrie Pickett
All providers in Alba, TX · Licensed Vocational Nurse in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 22, 2020. 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.