1760765622 NPI number — MRS. JANE ELLEN WILLIAMS BACHELORS OF SCIENCE

Table of content: MRS. JANE ELLEN WILLIAMS BACHELORS OF SCIENCE (NPI 1760765622)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760765622 NPI number — MRS. JANE ELLEN WILLIAMS BACHELORS OF SCIENCE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
JANE
Provider Middle Name:
ELLEN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
BACHELORS OF SCIENCE
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:
1760765622
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3155 MEADOW VIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PACIFIC
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63069-4500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-271-7944
Provider Business Mailing Address Fax Number:
636-239-7941

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
890 WASHINGTON CORS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63090-4603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-239-7483
Provider Business Practice Location Address Fax Number:
636-239-7941
Provider Enumeration Date:
09/27/2011

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: 183500000X , with the licence number:  044558 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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