Individual
THERESA M. WILLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
5201 HARRY HINES BLVD, MEDICAL STAFF SERVICES, DALLAS, TX 75235-7708
(214) 590-8006
Mailing address
PO BOX 660599, DALLAS, TX 75266-0599
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
510769
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
041569702
—
TX
05
—
041569703
—
TX
05
—
041569704
—
TX
01
—
8N4772
BLUE CROSS BLUE SHIELD
TX
Enumeration date
07/21/2005
Last updated
11/22/2008
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