MEDICARE: MS. VALJA JEAN WILLIAMS RN, SN

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	163WS0200X	School Registered Nurse	RN090955	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528199726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VALJA JEAN WILLIAMS RN, SN

Provider Business Mailing Address
First Line	:	80 W. BATEMAN COURT,
Second Line	:
City	:	COLORADO CITY
State	:	AZ
Zip	:	86021-1196
Country	:	US
Telephone Number	:	928-875-8260
Fax Number	:

Provider Business Practice Location Address
First Line	:	255 N. COTTONWOOD ST.
Second Line	:
City	:	COLORADO CITY
State	:	AZ
Zip	:	86021-0309
Country	:	US
Telephone Number	:	928-875-9000
Fax Number	:

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

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	07/09/2007

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