Provider Demographics
NPI:1508848177
Name:WILEY, CAROL A (FNP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:WILEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 939
Mailing Address - Street 2:
Mailing Address - City:ANGELS CAMP
Mailing Address - State:CA
Mailing Address - Zip Code:95222-0939
Mailing Address - Country:US
Mailing Address - Phone:209-754-6262
Mailing Address - Fax:209-754-6274
Practice Address - Street 1:13975 MONO WAY
Practice Address - Street 2:SUITE G
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-2824
Practice Address - Country:US
Practice Address - Phone:209-533-9600
Practice Address - Fax:209-533-9608
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7385363L00000X
CANP7385363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACE068Medicare PIN
CAQ20738Medicare UPIN