Provider Demographics
NPI:1366107542
Name:ATWELL, WILLA ALEXIS (RN)
Entity type:Individual
Prefix:
First Name:WILLA
Middle Name:ALEXIS
Last Name:ATWELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 KINGFISH RD
Mailing Address - Street 2:
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-3705
Mailing Address - Country:US
Mailing Address - Phone:561-685-8209
Mailing Address - Fax:
Practice Address - Street 1:150 W 22ND ST
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404-5512
Practice Address - Country:US
Practice Address - Phone:561-685-8209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-03
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5213347251J00000X
FLRN3646134207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No251J00000XAgenciesNursing Care