Provider Demographics
NPI:1427219831
Name:WILLIS, ANNE LINN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:LINN
Last Name:WILLIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANNE
Other - Middle Name:LINN
Other - Last Name:SEIDENSTICKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:WAKE FOREST UNIVERSITY BAPTIST MEDICAL CTR
Mailing Address - Street 2:MEDICAL CENTER BLVD
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-716-5222
Mailing Address - Fax:
Practice Address - Street 1:WAKE FOREST UNIVERSITY BAPTIST MEDICAL CTR
Practice Address - Street 2:MEDICAL CENTER BLVD
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-716-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2011-00491207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5917626Medicaid
NCNC1237AMedicare PIN