MEDICARE: S. ELIZABETH WILLIAMS APRN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	202960-4405	UT

General Provider Information

NPI Number	:	1497770333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	S. ELIZABETH WILLIAMS APRN

Provider Business Mailing Address
First Line	:	PO BOX 581403
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84158-1403
Country	:	US
Telephone Number	:	801-486-4036
Fax Number	:	801-487-4283

Provider Business Practice Location Address
First Line	:	1399 S 700 E
Second Line	:	SUITE 12
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-2149
Country	:	US
Telephone Number	:	801-486-4036
Fax Number	:	801-487-4209

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	07/08/2007

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