Individual provider · Type 1 NPI

Glen Willis, LPN

Licensed Practical Nurse · Coram, NY

NPI number 1326585902 Active

Practice location

1807 Rugby Pl Apt B
Coram, NY 11727-5427

Call (631) 627-9455 Map

Specialties and licenses

TaxonomyCodeLicense
Licensed Practical Nurse Primary 164W00000X310633-1 (NY)

Licensed Practical Nurse: An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.

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About NPI 1326585902

Glen Willis, LPN's National Provider Identifier is 1326585902, issued on Jan 20, 2017. The primary taxonomy on file is Licensed Practical Nurse (164W00000X), and the practice location is in Coram, NY. The record was last updated on Jan 20, 2017.