MEDICARE: MS. VALERIA L. WILLIAMS NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	209-006290	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	041-233585	OTHER	IL	REGISTERED NURSE
2	309-003250	OTHER	IL	APN CONTROLLED SUBSTANCE
3	209-006290	OTHER	IL	APN

General Provider Information

NPI Number	:	1043436389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VALERIA L. WILLIAMS NP

Provider Business Mailing Address
First Line	:	924 UNION DR
Second Line	:
City	:	UNIVERSITY PARK
State	:	IL
Zip	:	60466-3035
Country	:	US
Telephone Number	:	708-534-0026
Fax Number	:

Provider Business Practice Location Address
First Line	:	3409 W FULLERTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-2415
Country	:	US
Telephone Number	:	773-486-5001
Fax Number	:	773-486-5020

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	11/13/2015

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