Provider Demographics
NPI:1285716365
Name:TERRY, WILLA MICHELLE (MD)
Entity type:Individual
Prefix:DR
First Name:WILLA
Middle Name:MICHELLE
Last Name:TERRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:TERRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4800 SAND POINT WAY NE # FA215
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-3901
Mailing Address - Country:US
Mailing Address - Phone:206-987-8232
Mailing Address - Fax:206-985-3201
Practice Address - Street 1:4800 SAND POINT WAY NE # FA215
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105
Practice Address - Country:US
Practice Address - Phone:206-987-8232
Practice Address - Fax:206-985-3201
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00028730208000000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA370017320OtherRAILROAD MEDICARE
WA8139156Medicaid
WA8139156Medicaid