Willis Metobo, RN

Primary specialty

Critical Care Medicine Registered NurseTaxonomy code 163WC0200X

License

806397 Issued in CA

Practice address

8063 Ryland Dr
El Dorado Hills, CA 95762-9450

Phone

(269) 470-0997

NPI assigned

Jul 22, 2024

Sex

Male

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

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1721606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721606400000",
    "number": "1902634173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8063 RYLAND DR",
            "city": "EL DORADO HILLS",
            "state": "CA",
            "postal_code": "957629450",
            "telephone_number": "269-470-0997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8063 RYLAND DR",
            "city": "EL DORADO HILLS",
            "state": "CA",
            "postal_code": "957629450",
            "telephone_number": "269-470-0997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "METOBO",
        "first_name": "WILLIS",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-07-22",
        "last_updated": "2024-07-22",
        "certification_date": "2024-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Critical Care Medicine",
            "state": "CA",
            "license": "806397",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Critical Care Medicine Registered Nurse in El Dorado Hills, CA
• Providers in El Dorado Hills, CA by specialty
• Critical Care Medicine Registered Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 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.