CHANEL LAWANDA WILLIS MD - NPI 1487359188 - Student in an Organized Health Care Education/Training Program in Newport News, VA

Q: What is Chanel Willis's NPI number?

The NPI number for Chanel Willis is 1487359188. It was assigned to this individual provider in the NPPES registry on April 3, 2023.

Q: What is Chanel Willis's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Chanel Willis was last updated on April 17, 2023. NPI Profile syncs with the weekly NPPES data releases published by CMS.

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About Chanel Lawanda Willis Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CHANEL LAWANDA WILLIS MD (NPI 1487359188) is an individual student in an organized health care education/training program in Newport News, Virginia and active in the NPI registry since April 2023. She is enrolled in Medicare PECOS and is a graduate of Other (2022).

NPPES Registry Identity

NPI1487359188

Entity TypeIndividualFemale

Primary Taxonomy390200000X

Provider Legal NameCHANEL LAWANDA WILLISCredential: MD

Location Address10510 JEFFERSON AVE STE BNewport News, VA 23601-3102

Mailing Address10510 Jefferson Ave Ste ANewport News, VA 23601-3102 · (757) 594-3800 · Fax (757) 591-9021

Phone(757) 594-3800

Fax(757) 591-9021

Sole ProprietorNo

Medical School CMSOtherGraduated 2022

Enumeration DateApril 3, 2023

Last NPPES UpdateApril 17, 2023

NPPES CertifiedApril 17, 2023

✔ NPI 1487359188 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

10510 JEFFERSON AVE STE B, Newport News, VA 23601

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Chanel Lawanda Willis Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID8224498274

PECOS Enrollment IDI20260413002728

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KRISTINA J FISHER

Family Medicine