Provider Demographics
NPI:1639405749
Name:WILLS, LEAH MARIA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:MARIA
Last Name:WILLS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 WESTOVER DR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330
Mailing Address - Country:US
Mailing Address - Phone:919-897-2250
Mailing Address - Fax:
Practice Address - Street 1:1602 WESTOVER DR
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-7026
Practice Address - Country:US
Practice Address - Phone:919-897-2250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-23
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7385363A00000X
OH002991363A00000X
NC0010-06814363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1639405749Medicaid