1922299742 NPI number — MS. JUDITH LYNN WILLIAMSON RN, APRN-BC, FNP,

Table of content: MS. JUDITH LYNN WILLIAMSON RN, APRN-BC, FNP, (NPI 1922299742)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922299742 NPI number — MS. JUDITH LYNN WILLIAMSON RN, APRN-BC, FNP,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMSON
Provider First Name:
JUDITH
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RN, APRN-BC, FNP,
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:
1922299742
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5666 E STATE ST
Provider Second Line Business Mailing Address:
OSF SAINT ANTHONY MED. CENTER, CENTER FOR CANCER CARE
Provider Business Mailing Address City Name:
ROCKFORD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61108-2425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-227-2663
Provider Business Mailing Address Fax Number:
815-227-2658

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8940 N WOOD SAGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEORIA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61615-7822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-243-3000
Provider Business Practice Location Address Fax Number:
309-243-3063
Provider Enumeration Date:
08/06/2007

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: 363LF0000X , with the licence number:  309-001477 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 209006790 , 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)





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