Healthcare Provider Details

I. General information

NPI: 1407547862
Provider Name (Legal Business Name): MARLENE ROLYNN WILLIAMS REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 05/17/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DALLAS VA MEDICAL CENTER
DALLAS TX
75216
US

IV. Provider business mailing address

8811 ELDORADO PKWY APT 4328
FRISCO TX
75033-3335
US

V. Phone/Fax

Practice location:
  • Phone: 214-742-8387
  • Fax:
Mailing address:
  • Phone: 813-918-8706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number776250
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: