Healthcare Provider Details

I. General information

NPI: 1760738108
Provider Name (Legal Business Name): CARRIE MARIE WILLIAMS CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2012
Last Update Date: 08/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE
CLEVELAND OH
44106-1716
US

IV. Provider business mailing address

21520 ROBINHOOD AVE
FAIRVIEW PARK OH
44126-2747
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-5324
  • Fax:
Mailing address:
  • Phone: 440-241-5997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN.323116-COA1
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberCOA.13555-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: