Physician Compare National (NPI:1225486020)

HEALTHCARE PROVIDER:

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1225486020
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0547556847
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20161208001521
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	WILLIAMS
	Individual professional last name
Provider First Name	MONNIE
	Individual professional first name
Provider Middle Name	COLLEEN
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2015
	Individual professional's medical school graduation year
Primary Specialty	NURSE PRACTITIONER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	3505 S BUCKNER BLVD
	Group Practice or individual's line 1 address
Line 2 Street Address	BRENTWOOD HEALTHCARE
	Group Practice or individual's line 2 address
City	DALLAS
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	752275451
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y