MEDICARE: WOMEN'S FUNCTIONAL HEALTH AND HORMONE CE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	2005000798	MO

General Provider Information

NPI Number	:	1023400272
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOMEN'S FUNCTIONAL HEALTH AND HORMONE CE

Provider Business Mailing Address
First Line	:	1055 OZARK CARE DR
Second Line	:
City	:	OSAGE BEACH
State	:	MO
Zip	:	65065-3016
Country	:	US
Telephone Number	:	573-693-1516
Fax Number	:	573-693-1519

Provider Business Practice Location Address
First Line	:	1055 OZARK CARE DR
Second Line	:
City	:	OSAGE BEACH
State	:	MO
Zip	:	65065-3016
Country	:	US
Telephone Number	:	573-693-1516
Fax Number	:	573-693-1519

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	SONJA GAYLE WILLIAMS
Credential	:	D.O.
Telephone Number	:	573-693-1516

Provider Enumeration Date	:	02/25/2015
Last Update Date	:	02/25/2015

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