Healthcare Provider Details

I. General information

NPI: 1174709455
Provider Name (Legal Business Name): WENDY J WILLEY RN, MS, ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 11/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 WASHINGTON VILLAGE DR SUITE 230
DAYTON OH
45459-3953
US

IV. Provider business mailing address

7700 WASHINGTON VILLAGE DR SUITE 220
DAYTON OH
45459-3953
US

V. Phone/Fax

Practice location:
  • Phone: 937-438-0099
  • Fax: 937-438-0902
Mailing address:
  • Phone: 937-438-0099
  • Fax: 937-438-0902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberCOA.09939-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: