Healthcare Provider Details

I. General information

NPI: 1174645113
Provider Name (Legal Business Name): JOANNE MARLENE WILLIAMS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8712 CHAMBERS PL NE
ALBUQUERQUE NM
87111-2138
US

IV. Provider business mailing address

8712 CHAMBERS PL NE
ALBUQUERQUE NM
87111-2138
US

V. Phone/Fax

Practice location:
  • Phone: 505-797-1944
  • Fax: 505-821-2280
Mailing address:
  • Phone: 505-797-1944
  • Fax: 505-821-2280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR19039
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: