Healthcare Provider Details

I. General information

NPI: 1063973857
Provider Name (Legal Business Name): SHEKIRA J WILLIAMS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 03/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S BALLENGER HWY
FLINT MI
48532-3638
US

IV. Provider business mailing address

2306 W STEWART AVE
FLINT MI
48504-3710
US

V. Phone/Fax

Practice location:
  • Phone: 810-342-2000
  • Fax:
Mailing address:
  • Phone: 248-778-6688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704274285
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: