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Mr. Glen Willis, LPN
Licensed Practical Nurse in Coram, New York
NPI 1326585902

Glen Willis is a Licensed Practical Nurse based in Coram, NY. Glen Willis practices in Coram, NY and has the professional credentials of LPN. The NPI Number for Glen Willis is 1326585902 and holds a License No. 310633-1 (New York).

The current practice location address for Glen Willis is 1807 Rugby Pl Apt B, Coram, NY and can be reached out via phone at 631-627-9455.

Location: 1807 Rugby Pl Apt B, Coram, NY, 11727-5427
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1326585902
Provider Name
Glen Willis
Credential
LPN
Provider Entity Type
Individual
Gender
Male
Address
1807 Rugby Pl Apt B, Coram, NY, 11727-5427
Phone Number
631-627-9455
Fax Number
Provider Enumeration Date
01/20/2017
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
1807 Rugby Pl Apt B
City
Coram
State
New York
Zip
11727-5427
Phone Number
631-627-9455
Fax Number
person
Provider Business Mailing Address Details
Address
1807 Rugby Pl Apt B
City
Coram
State
New York
Zip
11727-5427
Phone Number
631-627-9455
Fax Number
person
Provider's Taxonomy Details 1
Type
Nursing Service Providers
Classification
Licensed Practical Nurse
Speciality
-
Taxonomy
164W00000X
License No.
310633-1 (New York)
Definition
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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