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NPI Code Detail

MEDICARE: MERRILL WILLIAMS

MEDICARE: MERRILL WILLIAMS
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
1172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1255767539
Entity Type Code : Individual
Provider Name (Legal Business Name) : MERRILL WILLIAMS
Provider Business Mailing Address
First Line : 2900 EL CAMINO AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-4203
Country : US
Telephone Number : 702-628-0408
Fax Number :
Provider Business Practice Location Address
First Line : 2900 EL CAMINO AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-4203
Country : US
Telephone Number : 702-628-0408
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/18/2013
Last Update Date : 09/18/2013

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