Healthcare Provider Details

I. General information

NPI: 1528199726
Provider Name (Legal Business Name): VALJA JEAN WILLIAMS RN, SN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 N. COTTONWOOD ST.
COLORADO CITY AZ
86021-0309
US

IV. Provider business mailing address

80 W. BATEMAN COURT,
COLORADO CITY AZ
86021-1196
US

V. Phone/Fax

Practice location:
  • Phone: 928-875-9000
  • Fax:
Mailing address:
  • Phone: 928-875-8260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN090955
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: