Healthcare Provider Details

I. General information

NPI: 1316284896
Provider Name (Legal Business Name): NICOLE T WILLIAMS APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NICOLE T EVANS

II. Dates (important events)

Enumeration Date: 01/03/2013
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S DAMEN AVE
CHICAGO IL
60612-3728
US

IV. Provider business mailing address

820 S DAMEN AVE
CHICAGO IL
60612-3728
US

V. Phone/Fax

Practice location:
  • Phone: 312-569-8387
  • Fax:
Mailing address:
  • Phone: 708-323-6038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209008870
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209008870
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: