Healthcare Provider Details

I. General information

NPI: 1114918232
Provider Name (Legal Business Name): DEBORAH MCWILLIAMS RN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 04/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 BEAUBIEN ST DIVISION OF UROLOGY
DETROIT MI
48201-2119
US

IV. Provider business mailing address

24838 JAMESTOWNE RD
NOVI MI
48375-2278
US

V. Phone/Fax

Practice location:
  • Phone: 313-966-5371
  • Fax: 313-993-8738
Mailing address:
  • Phone: 248-348-7971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number4704104666
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704104666
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: