Healthcare Provider Details

I. General information

NPI: 1598263352
Provider Name (Legal Business Name): STEPHANIE WILLIAMS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2018
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W REX ALLEN DR
WILLCOX AZ
85643-1009
US

IV. Provider business mailing address

16810 S ORCHID FLOWER TRL
VAIL AZ
85641-2705
US

V. Phone/Fax

Practice location:
  • Phone: 520-384-3541
  • Fax: 520-384-6365
Mailing address:
  • Phone: 217-549-9887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP11241
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: