Healthcare Provider Details

I. General information

NPI: 1174505838
Provider Name (Legal Business Name): DIANA WILLIAMS RNC, WHMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 10/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12709 TOEPPERWEIN RD SUITE 309
LIVE OAK TX
78233-3258
US

IV. Provider business mailing address

1210 ARION PKWY
SAN ANTONIO TX
78216-2880
US

V. Phone/Fax

Practice location:
  • Phone: 210-657-4099
  • Fax: 210-599-9137
Mailing address:
  • Phone: 210-349-9300
  • Fax: 210-366-2558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberWIL-0429-7169
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: