Healthcare Provider Details

I. General information

NPI: 1699114843
Provider Name (Legal Business Name): DE-ANN R WILLIAMS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2013
Last Update Date: 10/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1470 N 16TH AVE
YAKIMA WA
98902
US

IV. Provider business mailing address

3800 SUMMITVIEW AVE
YAKIMA WA
98902-2715
US

V. Phone/Fax

Practice location:
  • Phone: 509-574-6000
  • Fax: 509-225-2714
Mailing address:
  • Phone: 509-248-7849
  • Fax: 509-248-8291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD60803850
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMD60803850
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: