Healthcare Provider Details

I. General information

NPI: 1316420565
Provider Name (Legal Business Name): MAEGON WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2018
Last Update Date: 09/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 21ST AVE E
SEATTLE WA
98112-5318
US

IV. Provider business mailing address

301 21ST AVE E
SEATTLE WA
98112-5318
US

V. Phone/Fax

Practice location:
  • Phone: 206-417-2107
  • Fax:
Mailing address:
  • Phone: 206-417-2107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN60287776
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: