Healthcare Provider Details

I. General information

NPI: 1093022931
Provider Name (Legal Business Name): JESSICA L WILLIAMS HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2010
Last Update Date: 09/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 GLENDON ST
WOLFEBORO NH
03894-4481
US

IV. Provider business mailing address

22 GLENDON ST
WOLFEBORO NH
03894-4481
US

V. Phone/Fax

Practice location:
  • Phone: 603-569-2799
  • Fax: 603-569-1815
Mailing address:
  • Phone: 603-569-2799
  • Fax: 603-569-1815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberH501
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: