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General NPI Number Information
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NPI Number | 1902358989
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Entity Type | Individual
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Provider Name | WENDY WILLIAMS PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/26/2016
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Last Update Date | 09/25/2023
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Provider Practice Location Address
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Address Line | 6824 NEWBURG RD
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City | ROCKFORD
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State | IL
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Zip | 61108-4330
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Country | US
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Telephone | 779-696-7610
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Fax |
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Provider Business Mailing Address
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Address Line | 202 W STATE ST STE 406
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City | ROCKFORD
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State | IL
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Zip | 61101-1146
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Country | US
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Telephone | 309-714-2390
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085009996
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License Number State | IL
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