=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598084337
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MISS DIANA RENEA WILLIAMS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2010
-----------------------------------------------------
Last Update Date | 05/18/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1115 CLEVELAND AVE NW
-----------------------------------------------------
City | CANTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44702-1815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-224-9634
-----------------------------------------------------
Fax | 330-451-1625
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1115 CLEVELAND AVE NW
-----------------------------------------------------
City | CANTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44702-1815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-224-9634
-----------------------------------------------------
Fax | 330-451-1625
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------