MEDICARE: DR. DANIELLE NICOLE WILLIAMS MD

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	111N00000X	Chiropractor	7704	AZ
2	207V00000X	Obstetrics & Gynecology Physician	R73420	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AZ0426440	OTHER	AZ	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1649208059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIELLE NICOLE WILLIAMS MD

Provider Business Mailing Address
First Line	:	5313 E PINCHOT AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-8039
Country	:	US
Telephone Number	:	602-309-4020
Fax Number	:

Provider Business Practice Location Address
First Line	:	5313 E PINCHOT AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-8039
Country	:	US
Telephone Number	:	602-309-4020
Fax Number	:

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

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	02/02/2016

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