Healthcare Provider Details

I. General information

NPI: 1144699125
Provider Name (Legal Business Name): HEATHER MARIE WILLIAMS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER OBERDANK PA-C

II. Dates (important events)

Enumeration Date: 09/19/2015
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 E WILCOX AVE
WHITE CLOUD MI
49349-8794
US

IV. Provider business mailing address

21422 15 MILE RD
LEROY MI
49655-8524
US

V. Phone/Fax

Practice location:
  • Phone: 231-689-5943
  • Fax: 231-689-1590
Mailing address:
  • Phone: 231-388-3746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601007554
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: