Provider Demographics
NPI:1972695070
Name:WILLEY, VICTORIA M (CRNP)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:M
Last Name:WILLEY
Suffix:
Gender:F
Credentials:CRNP
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Mailing Address - Street 1:8110 MAPLE LAWN BLVD STE 302
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-2693
Mailing Address - Country:US
Mailing Address - Phone:301-340-8339
Mailing Address - Fax:301-340-9027
Practice Address - Street 1:1165 IMPERIAL DR STE 200
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-6583
Practice Address - Country:US
Practice Address - Phone:301-466-5190
Practice Address - Fax:301-466-5190
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2023-12-05
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Provider Licenses
StateLicense IDTaxonomies
MDR097221363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD482501201Medicaid
MD482501201Medicaid
P01071Medicare UPIN
P01071Medicare UPIN