Provider Demographics
NPI:1063702652
Name:WILLIS, SHAWNDREA NICOLE (BS IN MATH)
Entity type:Individual
Prefix:
First Name:SHAWNDREA
Middle Name:NICOLE
Last Name:WILLIS
Suffix:
Gender:F
Credentials:BS IN MATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4828 SE 88TH TER
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73135-6306
Mailing Address - Country:US
Mailing Address - Phone:580-235-2938
Mailing Address - Fax:
Practice Address - Street 1:4828 SE 88TH TER
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73135-6306
Practice Address - Country:US
Practice Address - Phone:580-235-2938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-15
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor