Provider Demographics
NPI:1962215533
Name:WILLS, THERESA ANN (FNP-BC)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:ANN
Last Name:WILLS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20066
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-0066
Mailing Address - Country:US
Mailing Address - Phone:818-885-4574
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 20066
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-0066
Practice Address - Country:US
Practice Address - Phone:818-885-4574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704192647207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine