Healthcare Provider Details

I. General information

NPI: 1952317455
Provider Name (Legal Business Name): ANDREA WILLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 11/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2277 FAIR OAKS BLVD SUITE 402
SACRAMENTO CA
95825-5533
US

IV. Provider business mailing address

2277 FAIR OAKS BLVD STE 402
SACRAMENTO CA
95825-5596
US

V. Phone/Fax

Practice location:
  • Phone: 916-922-7546
  • Fax: 916-922-6647
Mailing address:
  • Phone: 916-922-7546
  • Fax: 916-922-6647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberA75733
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: