Healthcare Provider Details

I. General information

NPI: 1386235935
Provider Name (Legal Business Name): DARA LYNN WILLIAMS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2021
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10211 E MADERO AVE
MESA AZ
85209-1493
US

IV. Provider business mailing address

4103 S BRICE
MESA AZ
85212-4182
US

V. Phone/Fax

Practice location:
  • Phone: 480-635-2025
  • Fax:
Mailing address:
  • Phone: 623-444-5118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN178772
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: