MEDICARE: MARY ELLEN WILLIAMS ANP

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	363L00000X	Nurse Practitioner	A01411	AR

General Provider Information

NPI Number	:	1134177439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ELLEN WILLIAMS ANP

Provider Business Mailing Address
First Line	:	1114 POPLAR PL
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72756-4249
Country	:	US
Telephone Number	:	479-636-9235
Fax Number	:	479-631-0374

Provider Business Practice Location Address
First Line	:	1114 POPLAR PL
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72756-4249
Country	:	US
Telephone Number	:	479-636-9235
Fax Number	:	479-631-0374

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	07/08/2007

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