MEDICARE: MRS. BIANCA WILLIAMS QMHA, PWS

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	175T00000X	Peer Specialist	THW000105206	OR

General Provider Information

NPI Number	:	1659045920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BIANCA WILLIAMS QMHA, PWS

Provider Business Mailing Address
First Line	:	833 ANDERSON AVE STE 6
Second Line	:
City	:	COOS BAY
State	:	OR
Zip	:	97420-4641
Country	:	US
Telephone Number	:	530-526-5644
Fax Number	:

Provider Business Practice Location Address
First Line	:	833 ANDERSON AVE STE 6
Second Line	:
City	:	COOS BAY
State	:	OR
Zip	:	97420-4641
Country	:	US
Telephone Number	:	530-526-5644
Fax Number	:

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

Provider Enumeration Date	:	08/02/2021
Last Update Date	:	08/21/2023

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