Healthcare Provider Details

I. General information

NPI: 1770125908
Provider Name (Legal Business Name): CORY R WILLIAMS NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2019
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 E US HIGHWAY 6
VALPARAISO IN
46383-8947
US

IV. Provider business mailing address

900 W SUNSET DR APT 613
GLENWOOD IL
60425-1159
US

V. Phone/Fax

Practice location:
  • Phone: 219-983-8300
  • Fax: 219-983-8080
Mailing address:
  • Phone: 708-941-7448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number28231903A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number277002326
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: