Healthcare Provider Details

I. General information

NPI: 1851390918
Provider Name (Legal Business Name): LONNA L WILLIAMS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LONNA L WEAVER NP

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5330 E STOP 11 RD
INDIANAPOLIS IN
46237-6345
US

IV. Provider business mailing address

PO BOX 781076
DETROIT MI
48278-1076
US

V. Phone/Fax

Practice location:
  • Phone: 317-893-1900
  • Fax: 317-893-1901
Mailing address:
  • Phone: 317-528-4800
  • Fax: 317-865-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP 9425102
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number71001597A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: