ANDREA WILLEY, MD - NPI NUMBER 1952317455

Summary

Provider Name: ANDREA WILLEY, MD

NPI Number: 1952317455

Clasification: Dermatology (207NS0135X)

Specialization: Procedural Dermatology

Organization: ANDREA WILLEY MD A PROFESSIONAL MEDICAL CORPORATION

Address:
2277 FAIR OAKS BLVD
SUITE 402
SACRAMENTO, CA
ZIP 95825

Phone Number: (916) 922-7546



Detailed Information

Andrea Willey, MD is a procedural dermatologist in Sacramento, CA with 15 years of experience. The provider is procedural Dermatology, a subspecialty of Dermatology, encompassing a wide variety of surgical procedures and methods to remove or modify skin tissue for health or cosmetic benefit. These methods include scalpel surgery, laser surgery, chemical surgery, cryosurgery (liquid nitrogen), electrosurgery, aspiration surgery, liposuction, injection of filler substances, and Mohs micrographic controlled surgery (a special technique for the removal of growths, especially skin cancers). The assigned NPI number for this provider is 1952317455 and is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

Education
Medical School: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO SCHOOL OF MEDICINE
Graduation Year: 2000

The provider's business address is:

2277 FAIR OAKS BLVD
SUITE 402
SACRAMENTO, CA
ZIP 95825-533
Phone: (916) 922-7546

The enumeration date for this NPI number is 8/1/2006 and was last updated on 11/1/2013.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 207NS0135X Dermatology Procedural Dermatology A75733 CA No
2 207N00000X Dermatology MD26877 OR Yes

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1952317455 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 1 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Provider Last Name Legal Name WILLEY The last name of the provider. If the provider is an individual, this is the legal name.
4 Provider First Name ANDREA The first name of the provider, if the provider is an individual.
5 Provider Credential Text MD The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
6 Provider First Line Business Practice Location Address 2277 FAIR OAKS BLVD The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
7 Provider Second Line Business Practice Location Address SUITE 402 The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
8 Provider Business Practice Location Address City Name SACRAMENTO The city name in the location address of the provider being identified.
9 Provider Business Practice Location Address State Name CA The State code in the location of the provider being identified.
10 Provider Business Practice Location Address Postal Code 958255533 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
11 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
12 Provider Business Practice Location Address Telephone Number 9169227546 The telephone number associated with the location address of the provider being identified.
13 Provider Enumeration Date 8/1/2006 The date the provider was assigned a unique identifier (assigned an NPI).
14 Last Update Date 11/1/2013 The date that a record was last updated or changed.
15 Provider Gender Code F The code designating the provider’s gender if the provider is a person.
16 Healthcare Provider Taxonomy Code 1 207NS0135X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
17 Provider License Number 1 A75733 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
18 Provider License Number State Code 1 CA The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
19 Healthcare Provider Primary Taxonomy Switch 1 N
20 Healthcare Provider Taxonomy Code 2 207N00000X
21 Provider License Number 2 MD26877 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
22 Provider License Number State Code 2 OR The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
23 Healthcare Provider Primary Taxonomy Switch 2 Y
24 Is Sole Proprietor Y Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No

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This page was last updated on: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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