Individual provider · NPI-1

Mary Patricia Willms

Dietitian, Registered · Espanola, NM

NPI number1710174420
StatusActive
Last updated in NPPESSep 26, 2007

Details

NPI
1710174420
Entity type
Individual (NPI-1)
Name
Mary Patricia Willms
Sex
Female
Sole proprietor
Yes
Enumeration date
Sep 26, 2007
Last updated
Sep 26, 2007

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
133V00000X Dietitian, RegisteredLD-0659NMYes

Practice location

620 Coronado St.
Espanola, NM 87532

Phone 505-753-7395

Mailing address

2185 44th St
Apt. D
Los Alamos, NM 87544-1750

Phone 505-662-9843

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