Healthcare Provider Details

I. General information

NPI: 1477238491
Provider Name (Legal Business Name): CARLEE RAE WILLIAMSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 JOSEPH DR
FAIRVIEW HEIGHTS IL
62208-2806
US

IV. Provider business mailing address

104 JOSEPH DR
FAIRVIEW HEIGHTS IL
62208-2806
US

V. Phone/Fax

Practice location:
  • Phone: 573-275-5561
  • Fax:
Mailing address:
  • Phone: 573-275-5561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209035940
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: