Healthcare Provider Details

I. General information

NPI: 1063724383
Provider Name (Legal Business Name): KATIE MARIE WILLIAMS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2010
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 E SHEA BLVD 175
PHOENIX AZ
85028-3074
US

IV. Provider business mailing address

4545 E SHEA BLVD 175
PHOENIX AZ
85028-3074
US

V. Phone/Fax

Practice location:
  • Phone: 866-662-4560
  • Fax: 877-561-7566
Mailing address:
  • Phone: 866-662-4560
  • Fax: 877-561-7566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP010637
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: