| Doctor Name: | MR. CHARLES ALLEN WILEY |
| NPI Number: | 1134452311 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | ARNP |
| License Number: | AP60113600 |
| Business Practice Address: | 12400 E Marginal Way S Tukwila, WA - 981682559 |
| Business Phone Number: | 2069018801 |
| Business Fax Number: | |
| Mailing Address: | 12400 E Marginal Way S, TUKWILA |
| State: | WA |
| Postal Code: | 981682559 |
| Phone Number: | 2069018801 |
| Fax Number: | |
| NPI Enumeration Date: | 09/06/2009 |
| NPI Last Update Date: | 09/06/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | AP60113600 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |