Healthcare Provider Details

I. General information

NPI: 1992177729
Provider Name (Legal Business Name): DESIREE WILLIAMS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2015
Last Update Date: 07/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13755 N LITCHFIELD RD #105
SURPRISE AZ
85379-4287
US

IV. Provider business mailing address

13755 N LITCHFIELD RD #105
SURPRISE AZ
85379-4287
US

V. Phone/Fax

Practice location:
  • Phone: 623-322-5900
  • Fax:
Mailing address:
  • Phone: 623-322-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number6276
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: