1295947331 NPI number — MRS. LISA MARIE WILLIAMS RN, MS, AACRN

Table of content: MRS. LISA MARIE WILLIAMS RN, MS, AACRN (NPI 1295947331)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295947331 NPI number — MRS. LISA MARIE WILLIAMS RN, MS, AACRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
LISA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN, MS, AACRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295947331
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1509 MAPLE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOWNERS GROVE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60515-4526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-963-7958
Provider Business Mailing Address Fax Number:
312-926-9630

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
251 E HURON ST
Provider Second Line Business Practice Location Address:
GALTER PAVILION, SUITE 13-205
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60611-2908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-926-4114
Provider Business Practice Location Address Fax Number:
312-926-9630
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 364S00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com