Provider Demographics
NPI:1295101129
Name:WILLEY, SARA JEAN (APRN)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:JEAN
Last Name:WILLEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BUCKSPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04416-4612
Mailing Address - Country:US
Mailing Address - Phone:207-469-7371
Mailing Address - Fax:207-469-7306
Practice Address - Street 1:110 BROADWAY
Practice Address - Street 2:
Practice Address - City:BUCKSPORT
Practice Address - State:ME
Practice Address - Zip Code:04416-4612
Practice Address - Country:US
Practice Address - Phone:207-469-7371
Practice Address - Fax:207-469-7306
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-14
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP151045363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health