Healthcare Provider Details

I. General information

NPI: 1669666285
Provider Name (Legal Business Name): NOLAN RAY WILLIAMS APRN, BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 09/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N EAST AVE
JACKSON MI
49201-1753
US

IV. Provider business mailing address

WA FOOTE MEMORIAL HOSPITAL INC PROFESSIONAL BILLING PO BOX 67000, DEPARTMENT 272801
DETROIT MI
48267-2728
US

V. Phone/Fax

Practice location:
  • Phone: 517-841-1328
  • Fax: 517-841-1330
Mailing address:
  • Phone: 517-841-1328
  • Fax: 517-841-1330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4704207712
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: