Provider Demographics
NPI:1598103798
Name:WILLS, FAYE A (PA-C)
Entity type:Individual
Prefix:
First Name:FAYE
Middle Name:A
Last Name:WILLS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:FAYE
Other - Middle Name:A
Other - Last Name:HAMILTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 E OLNEY AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-2470
Mailing Address - Country:US
Mailing Address - Phone:215-456-1825
Mailing Address - Fax:215-456-5926
Practice Address - Street 1:1200 W TABOR RD FL 3
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3019
Practice Address - Country:US
Practice Address - Phone:215-456-3930
Practice Address - Fax:215-456-1432
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056172363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant