Healthcare Provider Details

I. General information

NPI: 1619268190
Provider Name (Legal Business Name): DAWN LYNN WILLIAMS NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2011
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4540 E BASELINE RD SUITE 114
MESA AZ
85206
US

IV. Provider business mailing address

PO BOX 748860
ATLANTA GA
30374-4617
US

V. Phone/Fax

Practice location:
  • Phone: 480-497-2229
  • Fax: 480-699-5681
Mailing address:
  • Phone: 480-497-2229
  • Fax: 480-699-5681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN064029
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP6992
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: