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General NPI Number Information
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NPI Number | 1922339449
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Entity Type | Individual
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Provider Name | NINA WILLIAMS MT(ASCP)
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Gender | Female
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Dates
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Enumeration Date | 01/22/2010
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Last Update Date | 01/22/2010
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Provider Practice Location Address
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Address Line | BLACK COAL RD BLDG 29
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City | FT WASHAKIE
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State | WY
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Zip | 82514
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Country | US
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Telephone | 307-332-7672
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Fax | 307-332-7514
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Provider Business Mailing Address
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Address Line | 315 HILLWOOD DR
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City | RIVERTON
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State | WY
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Zip | 82501-9336
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Country | US
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Telephone | 307-856-9281
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Fax | 307-857-2898
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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 | 246QM0706X
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Taxonomy Name | Medical Technologist
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License Number | MT 109011
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License Number State | WY
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