Healthcare Provider Details

I. General information

NPI: 1700426079
Provider Name (Legal Business Name): CHARISSA K WILLIAMS APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2020
Last Update Date: 01/31/2020
Certification Date: 01/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 E CAPITOL DRIVE
APPLETON WI
54911-8735
US

IV. Provider business mailing address

122 E COLLEGE AVE
APPLETON WI
54911-5741
US

V. Phone/Fax

Practice location:
  • Phone: 920-364-3600
  • Fax: 920-364-3900
Mailing address:
  • Phone: 920-996-3264
  • Fax: 920-830-5910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number197423
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9855
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: