MEDICARE: PAULA FAYE WILLIAMSON FNP

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	363LF0000X	Family Nurse Practitioner	RN1009384	DC
2	363LF0000X	Family Nurse Practitioner	209.007395	IL

General Provider Information

NPI Number	:	1356413900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULA FAYE WILLIAMSON FNP

Provider Business Mailing Address
First Line	:	1160 S MICHIGAN AVE
Second Line	:	#3005
City	:	CHICAGO
State	:	IL
Zip	:	60605-2776
Country	:	US
Telephone Number	:	312-929-3979
Fax Number	:	312-929-3979

Provider Business Practice Location Address
First Line	:	1160 S MICHIGAN AVE
Second Line	:	#3005
City	:	CHICAGO
State	:	IL
Zip	:	60605-2776
Country	:	US
Telephone Number	:	312-929-3979
Fax Number	:	312-929-3979

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

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	07/28/2009

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