Healthcare Provider Details

I. General information

NPI: 1710121413
Provider Name (Legal Business Name): STACY LYNN HOWELL WILLIAMS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2009
Last Update Date: 04/01/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL LN SUITE 200
DANVILLE IN
46122-1989
US

IV. Provider business mailing address

100 HOSPITAL LN STE 200
DANVILLE IN
46122-1993
US

V. Phone/Fax

Practice location:
  • Phone: 317-745-7337
  • Fax:
Mailing address:
  • Phone: 317-837-5571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01070781A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: