Provider Demographics
NPI:1871952507
Name:MERCHANT, WILLOW (FNP, RN, IBCLC)
Entity type:Individual
Prefix:
First Name:WILLOW
Middle Name:
Last Name:MERCHANT
Suffix:
Gender:F
Credentials:FNP, RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 W HILTON DR
Mailing Address - Street 2:
Mailing Address - City:BOULDER CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:95006-9207
Mailing Address - Country:US
Mailing Address - Phone:650-862-9336
Mailing Address - Fax:831-703-4773
Practice Address - Street 1:343 W HILTON DR
Practice Address - Street 2:
Practice Address - City:BOULDER CREEK
Practice Address - State:CA
Practice Address - Zip Code:95006-9207
Practice Address - Country:US
Practice Address - Phone:650-862-9336
Practice Address - Fax:831-703-4773
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA545590163WL0100X
CA16133363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant