1265752018 NPI number — NILA NORINE WILLIAMSON MPH, RD, CD

Table of content: NILA NORINE WILLIAMSON MPH, RD, CD (NPI 1265752018)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265752018 NPI number — NILA NORINE WILLIAMSON MPH, RD, CD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMSON
Provider First Name:
NILA
Provider Middle Name:
NORINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MPH, RD, CD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GREGORY
Provider Other First Name:
NILA
Provider Other Middle Name:
NORINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1265752018
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
323 MAPLE PARK AVE SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLYMPIA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98501-2360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-449-6791
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4800 SAND POINT WAY NE
Provider Second Line Business Practice Location Address:
M/S W3726
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98105-3901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-987-7767
Provider Business Practice Location Address Fax Number:
206-987-5087
Provider Enumeration Date:
06/03/2010

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: 133VN1004X , with the licence number:  DI 60043903 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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