Healthcare Provider Details

I. General information

NPI: 1073302147
Provider Name (Legal Business Name): RONNESE WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 13TH AVE
GREEN BAY WI
54304-2540
US

IV. Provider business mailing address

1200 13TH AVE
GREEN BAY WI
54304-2540
US

V. Phone/Fax

Practice location:
  • Phone: 920-873-0998
  • Fax:
Mailing address:
  • Phone: 920-873-0998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SH0200X
TaxonomyHome Health Clinical Nurse Specialist
License NumberNA
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code364SR0400X
TaxonomyRehabilitation Clinical Nurse Specialist
License NumberNA
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License NumberNA
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License NumberNA
License Number StateWI
# 5
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberNA
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberNA
License Number StateWI
# 7
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberNA
License Number StateWI
# 8
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberNA
License Number StateWI
# 9
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberNA
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: