Provider Demographics
NPI:1598335762
Name:WILLEY, ANNABELLE (PA-C)
Entity type:Individual
Prefix:
First Name:ANNABELLE
Middle Name:
Last Name:WILLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 VAN RENSSELAER BLVD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12204-1609
Mailing Address - Country:US
Mailing Address - Phone:315-761-3655
Mailing Address - Fax:
Practice Address - Street 1:92 VAN RENSSELAER BLVD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12204-1609
Practice Address - Country:US
Practice Address - Phone:315-761-3655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant