Provider Demographics
NPI:1528723913
Name:WILLIS, LAUREN MARIE (APRN)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:MARIE
Last Name:WILLIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 CARONDELET DR STE 201B
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4673
Mailing Address - Country:US
Mailing Address - Phone:913-956-2250
Mailing Address - Fax:913-956-2251
Practice Address - Street 1:1000 CARONDELET DR STE 201B
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4673
Practice Address - Country:US
Practice Address - Phone:913-956-2250
Practice Address - Fax:913-956-2251
Is Sole Proprietor?:No
Enumeration Date:2021-11-01
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020041285363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner