Healthcare Provider Details

I. General information

NPI: 1295117091
Provider Name (Legal Business Name): SENTORITA WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SENTORITA BENNETT

II. Dates (important events)

Enumeration Date: 06/29/2015
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 MADISON AVE FL 9
MEMPHIS TN
38103-3403
US

IV. Provider business mailing address

PO BOX 932958
CLEVELAND OH
44193-0028
US

V. Phone/Fax

Practice location:
  • Phone: 901-448-5630
  • Fax: 901-448-7255
Mailing address:
  • Phone: 901-453-2933
  • Fax: 901-457-2934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number19958
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number19958
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: