Basic Information
| Provider Information | |||||||||
| NPI: | 1447387311 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILLEY | ||||||||
| FirstName: | DEBORA | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | ARRT, RPA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 938 BANNOCK ST | ||||||||
| Address2: | STE 300 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802044028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039148800 | ||||||||
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| Practice Location | |||||||||
| Address1: | 938 BANNOCK ST | ||||||||
| Address2: | STE 300 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802044028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039148800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2007 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247100000X | X | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | 2471C3401X | X | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Computed Tomography | 2471M2300X | X | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Mammography |
ID Information
| ID | Type | State | Issuer | Description | 04004826 | 05 | CO | MEDICAID |