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NPI Code Detail

MEDICARE: STACY DAWN WILLIAMS RN

MEDICARE: STACY DAWN WILLIAMS RN
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1164175295
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACY DAWN WILLIAMS RN
Provider Business Mailing Address
First Line : 100 WASHINGTON AVE S STE 1210
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55401-2511
Country : US
Telephone Number : 800-925-3368
Fax Number :
Provider Business Practice Location Address
First Line : 100 WASHINGTON AVE S STE 1210
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55401-2511
Country : US
Telephone Number : 800-925-3368
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/29/2022
Last Update Date : 01/29/2022

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