Healthcare Provider Details

I. General information

NPI: 1043503774
Provider Name (Legal Business Name): GINA MARGARET WILLIAMS LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2011
Last Update Date: 05/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5227 BALLARD AVE NW
SEATTLE WA
98107-4809
US

IV. Provider business mailing address

7731 12TH AVE NW
SEATTLE WA
98117-4136
US

V. Phone/Fax

Practice location:
  • Phone: 206-854-0296
  • Fax:
Mailing address:
  • Phone: 206-854-0296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License NumberMA00024118
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA00024118
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: