Healthcare Provider Details

I. General information

NPI: 1548502495
Provider Name (Legal Business Name): DESIREE DIAN WILLIAMS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DESIREE DIAN ROSALES

II. Dates (important events)

Enumeration Date: 03/19/2013
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12750 SAINT FRANCIS DR STE 410
CROWN POINT IN
46307-0264
US

IV. Provider business mailing address

PO BOX 781076
DETROIT MI
48278-1076
US

V. Phone/Fax

Practice location:
  • Phone: 219-769-8340
  • Fax: 219-769-8341
Mailing address:
  • Phone: 317-528-4800
  • Fax: 317-865-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number28130302A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2013001517
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71004561A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: