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General NPI Number Information
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NPI Number | 1598857088
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Entity Type | Individual
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Provider Name | ELISA WILLIAMS DO
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Gender | Female
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 11/01/2017
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Provider Practice Location Address
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Address Line | 801 BROADWAY N
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City | FARGO
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State | ND
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Zip | 58102-3641
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Country | US
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Telephone | 701-234-6355
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Fax |
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Provider Business Mailing Address
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Address Line | 400 EAST THIRD STREET ESSENTIA HEALTH DULUTH CLINIC MCL2CRED
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City | DULUTH
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State | MN
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Zip | 55805-1951
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Country | US
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Telephone | 218-786-1183
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | R7890
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 11667
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License Number State | ND
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