Healthcare Provider Details

I. General information

NPI: 1578709929
Provider Name (Legal Business Name): JASON LEE WILLIAMS R.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2009
Last Update Date: 01/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HHC 121ST CSH # 707
APO AP
96205-5244
US

IV. Provider business mailing address

HHC 121ST CSH PO BOX # 707
APO AP
96205-5244
US

V. Phone/Fax

Practice location:
  • Phone: 210-218-3286
  • Fax:
Mailing address:
  • Phone: 210-218-3286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN0000128620
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: