Willow Family Medical Center

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

WILLOW FAMILY MEDICAL CENTER

Practice address

3434 Edwards Mill Rd Ste 112 PMB 348
Raleigh, NC 27612-4276

Phone

(919) 806-8686

Fax

(919) 787-2176

NPI assigned

Feb 14, 2007

Last updated

Sep 10, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Denise D Tollefson, M.D.

Title

President

Phone

(919) 806-8686

Specialties & licenses 1

Addresses

Other identifiers 3

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284076800000",
    "number": "1861534778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3434 EDWARDS MILL RD STE 112 PMB 348",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276124276",
            "telephone_number": "919-806-8686",
            "fax_number": "919-787-2176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3434 EDWARDS MILL RD STE 112 PMB 348",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276124276",
            "telephone_number": "919-806-8686",
            "fax_number": "919-787-2176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW FAMILY MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-14",
        "last_updated": "2010-09-10",
        "status": "A",
        "authorized_official_last_name": "TOLLEFSON",
        "authorized_official_first_name": "DENISE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "919-806-8686",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP",
            "identifier": "02150",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "2242750",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLPATH COVENTRY",
            "identifier": "39308",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cynthia Laveda Willis, M.ED., CCC-SLP
• Danielle Leann Shelley Willis, PA-C
• Elizabeth Willis, DO
• Leah Nixon Willis, MD
• Emily Willner, M.D.
• Willow Grace Counseling, PLLC
• Imari Wills
• Adam Kenneth Willson, M.D
• Kathryn Lynn Willson, PA-C
• Kayla Nicole Wilmot

• Family Medicine Physician in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.