1245376839 NPI number — MS. MARIE BERTON WILLIAMS CRNFA

Table of content: MS. MARIE BERTON WILLIAMS CRNFA (NPI 1245376839)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245376839 NPI number — MS. MARIE BERTON WILLIAMS CRNFA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
MARIE
Provider Middle Name:
BERTON
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CRNFA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILLIAMS
Provider Other First Name:
MARIE
Provider Other Middle Name:
LOUISE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNFA
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1245376839
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:
130 RODEO RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORMOND BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32174-7928
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-677-0762
Provider Business Mailing Address Fax Number:
386-677-0762

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 RODEO RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORMOND BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32174-7928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-677-0762
Provider Business Practice Location Address Fax Number:
386-677-0762
Provider Enumeration Date:
01/30/2007

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: 163WR0006X , with the licence number:  89722-2 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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