Healthcare Provider Details

I. General information

NPI: 1295192433
Provider Name (Legal Business Name): CORA CELESTE WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2016
Last Update Date: 08/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3356 E PATRICK LN
LAS VEGAS NV
89120
US

IV. Provider business mailing address

3556 E PATRICK LN
LAS VEGAS NV
89120-3239
US

V. Phone/Fax

Practice location:
  • Phone: 702-809-0464
  • Fax:
Mailing address:
  • Phone: 702-809-0464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: