MEDICARE: MS. DEANNE R WILLIAMS CNM

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	367A00000X	Advanced Practice Midwife	1993124402	UT

General Provider Information

NPI Number	:	1679759278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEANNE R WILLIAMS CNM

Provider Business Mailing Address
First Line	:	5121 S COTTONWOOD STREET
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84157-7000
Country	:	US
Telephone Number	:	801-634-2114
Fax Number	:

Provider Business Practice Location Address
First Line	:	5121 S COTTONWOOD STREET
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84157-7000
Country	:	US
Telephone Number	:	801-634-2114
Fax Number	:

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

Provider Enumeration Date	:	01/14/2008
Last Update Date	:	01/14/2008

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