Individual ProviderCasandra WillisRegistered NurseNursing Service ProvidersPractice Address44 N Main St, Spring Valley, NY 10977-4906(718) 828-2666PECOS EnrollmentBased on the most recent information from CMS, provider Casandra Willis does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 11:54 AM.Profile DetailsProvider ID1063044550Provider TypeIndividualFull NameWillis, CasandraGenderFemaleSole ProprietorYesEnumeration Date2/12/2020Last Updated2/12/2020Contact InformationPractice LocationPractice Address44 N Main St, Spring Valley, NY 10977-4906Phone(718) 828-2666FaxUnlisted FaxMailing LocationMailing Address44 N Main St, Spring Valley, NY 10977-4906Phone(718) 828-2666FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode163W00000XPrimaryDescriptionRegistered NurseNursing Service ProvidersLicense665903New York