Provider Demographics
NPI:1699812610
Name:WILLS, SHARYN A (APN)
Entity Type:Individual
Prefix:MRS
First Name:SHARYN
Middle Name:A
Last Name:WILLS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 HAZEL ST
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-2006
Mailing Address - Country:US
Mailing Address - Phone:908-272-1609
Mailing Address - Fax:
Practice Address - Street 1:90 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503-1804
Practice Address - Country:US
Practice Address - Phone:973-321-2256
Practice Address - Fax:973-321-2254
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00052500363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics