Provider Demographics
NPI:1174709455
Name:WILLEY, WENDY J (RN, MS, ACNP)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:J
Last Name:WILLEY
Suffix:
Gender:F
Credentials:RN, MS, ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 WASHINGTON VILLAGE DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-3953
Mailing Address - Country:US
Mailing Address - Phone:937-438-0099
Mailing Address - Fax:937-438-0902
Practice Address - Street 1:7700 WASHINGTON VILLAGE DR
Practice Address - Street 2:SUITE 230
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-3953
Practice Address - Country:US
Practice Address - Phone:937-438-0099
Practice Address - Fax:937-438-0902
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.09939-NP363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care