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General NPI Number Information
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NPI Number | 1538835392
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Entity Type | Individual
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Provider Name | JACYNA ANN WILLIAMS
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Gender | Female
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Dates
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Enumeration Date | 08/20/2021
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Last Update Date | 08/20/2021
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Provider Practice Location Address
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Address Line | 2814 S 108TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53227-3224
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Country | US
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Telephone | 414-916-2596
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Fax |
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Provider Business Mailing Address
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Address Line | 8444 N 90TH ST STE 100
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-4437
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Country | US
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Telephone | 480-494-2486
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Fax |
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 326477-31
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License Number State | WI
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