Individual
WENDY WILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3802 MAIN ST, OCCIDENTAL, CA 95465
(707) 874-2444
(707) 874-1664
Mailing address
PO BOX 1449, GUERNEVILLE, CA 95446-1449
(707) 869-5977
(707) 869-5983
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA11243
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1598768962
—
CA
01
—
PA11243
STATE LICENSE NUMBER
CA
Enumeration date
08/19/2006
Last updated
06/25/2015
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