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General NPI Number Information
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NPI Number | 1144977935
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Entity Type | Individual
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Provider Name | TIERRA WILLIAMS
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Gender | Female
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Dates
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Enumeration Date | 03/02/2022
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 2450 N CENTRAL AVE
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City | CHICAGO
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State | IL
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Zip | 60639-1316
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Country | US
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Telephone | 773-889-1333
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Fax | 847-221-6942
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Provider Business Mailing Address
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Address Line | 1025 CHARLELA LN APT 305
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City | ELK GROVE VILLAGE
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State | IL
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Zip | 60007-3258
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Country | US
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Telephone | 309-807-6769
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Fax | 847-221-6942
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 209024848
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 209024848
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License Number State | IL
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