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General NPI Number Information
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NPI Number | 1023400272
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Entity Type | Organization
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Legal Business Name | WOMEN'S FUNCTIONAL HEALTH AND HORMONE CE
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Dates
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Enumeration Date | 02/25/2015
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Last Update Date | 02/25/2015
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Provider Practice Location Address
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Address Line | 1055 OZARK CARE DR
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City | OSAGE BEACH
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State | MO
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Zip | 65065-3016
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Country | US
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Telephone | 573-693-1516
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Fax | 573-693-1519
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Provider Business Mailing Address
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Address Line | 1055 OZARK CARE DR
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City | OSAGE BEACH
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State | MO
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Zip | 65065-3016
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Country | US
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Telephone | 573-693-1516
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Fax | 573-693-1519
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Authorized Official
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Title or Position | PHYSICIAN
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Name | SONJA GAYLE WILLIAMS
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Credential | D.O.
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Telephone | 573-693-1516
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 2005000798
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License Number State | MO
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