MEDICARE: LYNDA A WILLIAMS CRNA

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	367500000X	Certified Registered Nurse Anesthetist	R49028	NM

General Provider Information

NPI Number	:	1821016080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNDA A WILLIAMS CRNA

Provider Business Mailing Address
First Line	:	14005 WIND MOUNTAIN RD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-6521
Country	:	US
Telephone Number	:	505-385-3607
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 SPRUCE ST
Second Line	:
City	:	ESPANOLA
State	:	NM
Zip	:	87532-2724
Country	:	US
Telephone Number	:	505-753-7111
Fax Number	:

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	03/07/2023

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