Active NPI
Mary Jo Willis, NP
- Nurse Practitioner
- Madison, WI
National Provider Identifier
1679537294
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 43266
- Practice address
- 2880 University Ave
Madison, WI 53705 - Phone
- (608) 263-7500
- Fax
- (608) 833-6932
- NPI assigned
- Apr 12, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 43266 | WI | Primary |
Addresses
Primary practice location
2880 University Ave
Madison, WI 53705
Mailing address
8007 Excelsior Drive
Madison, WI 53717
Phone (608) 829-5201
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 43829500 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 43266 | WI | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144800000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1679537294",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8007 EXCELSIOR DRIVE",
"city": "MADISON",
"state": "WI",
"postal_code": "53717",
"telephone_number": "608-829-5201",
"fax_number": "608-833-6932"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2880 UNIVERSITY AVE",
"city": "MADISON",
"state": "WI",
"postal_code": "53705",
"telephone_number": "608-263-7500",
"fax_number": "608-833-6932"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIS",
"first_name": "MARY JO",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-04-12",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "WI",
"license": "43266",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "43829500",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Madison, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.