Provider Demographics
NPI:1023202082
Name:WILLEY, LINDSEY ANNE (PAC)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:ANNE
Last Name:WILLEY
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:ANNE
Other - Last Name:TOWNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1412 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:TIPTON
Mailing Address - State:IA
Mailing Address - Zip Code:52772-1100
Mailing Address - Country:US
Mailing Address - Phone:515-886-2182
Mailing Address - Fax:563-886-2732
Practice Address - Street 1:1412 CEDAR ST
Practice Address - Street 2:
Practice Address - City:TIPTON
Practice Address - State:IA
Practice Address - Zip Code:52772-1100
Practice Address - Country:US
Practice Address - Phone:515-886-2182
Practice Address - Fax:563-886-2732
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001839363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI21498Medicare PIN