Provider Demographics
NPI:1104424803
Name:WILLIS, LORRAINE (BSW)
Entity type:Individual
Prefix:MS
First Name:LORRAINE
Middle Name:
Last Name:WILLIS
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6401 A ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-1824
Mailing Address - Country:US
Mailing Address - Phone:907-580-0542
Mailing Address - Fax:
Practice Address - Street 1:6401 A ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-1824
Practice Address - Country:US
Practice Address - Phone:907-580-0542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator