MEDICARE: SHARYSE L 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
1	163WM0705X	Medical-Surgical Registered Nurse		OR

General Provider Information

NPI Number	:	1205057908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARYSE L WILLIAMS RN

Provider Business Mailing Address
First Line	:	2750 W HARVARD AVE
Second Line	:
City	:	ROSEBURG
State	:	OR
Zip	:	97470-2608
Country	:	US
Telephone Number	:	541-673-8988
Fax Number	:	541-672-8103

Provider Business Practice Location Address
First Line	:	2801 NW MERCY DR
Second Line	:	SUITE 330
City	:	ROSEBURG
State	:	OR
Zip	:	97470-2348
Country	:	US
Telephone Number	:	541-677-3600
Fax Number	:	541-677-3601

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

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	07/08/2007

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