MEDICARE: DR. LEANNA BRUEN WILLEY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	9800163	NC

General Provider Information

NPI Number	:	1215947031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEANNA BRUEN WILLEY M.D.

Provider Business Mailing Address
First Line	:	2605 BLUE RIDGE RD
Second Line	:	SUITE 100
City	:	RALEIGH
State	:	NC
Zip	:	27607-6475
Country	:	US
Telephone Number	:	919-881-9009
Fax Number	:	919-881-8463

Provider Business Practice Location Address
First Line	:	2605 BLUE RIDGE RD
Second Line	:	SUITE 100
City	:	RALEIGH
State	:	NC
Zip	:	27607-6475
Country	:	US
Telephone Number	:	919-881-9009
Fax Number	:	919-881-8463

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	07/08/2007

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