Healthcare Provider Details

I. General information

NPI: 1366078578
Provider Name (Legal Business Name): AMBER WILLIAMS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2020
Last Update Date: 03/19/2020
Certification Date: 03/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 W 15TH ST
PLANO TX
75075-7299
US

IV. Provider business mailing address

1089 W EXCHANGE PKWY APT 5206
ALLEN TX
75013-7040
US

V. Phone/Fax

Practice location:
  • Phone: 469-263-9372
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number930754
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: