Provider Demographics
NPI:1649370628
Name:WILLETT, WILLIAM NICHOLAS (RPA-C)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:NICHOLAS
Last Name:WILLETT
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
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Mailing Address - Street 1:45 EVERGREEN ST
Mailing Address - Street 2:
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559-1307
Mailing Address - Country:US
Mailing Address - Phone:585-275-3310
Mailing Address - Fax:585-271-2106
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:BOX MED-HMD
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-275-3310
Practice Address - Fax:585-271-2106
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2023-07-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY8313363A00000X
NY008313-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant