Healthcare Provider Details

I. General information

NPI: 1922299742
Provider Name (Legal Business Name): JUDITH LYNN WILLIAMSON RN, APRN-BC, FNP,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8940 N WOOD SAGE RD
PEORIA IL
61615-7822
US

IV. Provider business mailing address

5666 E STATE ST OSF SAINT ANTHONY MED. CENTER, CENTER FOR CANCER CARE
ROCKFORD IL
61108-2425
US

V. Phone/Fax

Practice location:
  • Phone: 309-243-3000
  • Fax: 309-243-3063
Mailing address:
  • Phone: 815-227-2663
  • Fax: 815-227-2658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number309-001477
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209006790
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: