MEDICARE: DAISY WILLIAMS RN AND ELECTROLOGIST

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	163W00000X	Registered Nurse	910554	TX

General Provider Information

NPI Number	:	1700358355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAISY WILLIAMS RN AND ELECTROLOGIST

Provider Business Mailing Address
First Line	:	6440 BELHAVEN DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-2096
Country	:	US
Telephone Number	:	307-772-1042
Fax Number	:

Provider Business Practice Location Address
First Line	:	4824 SW LOOP 820 STE 220
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-4420
Country	:	US
Telephone Number	:	682-200-3278
Fax Number	:

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

Provider Enumeration Date	:	12/20/2018
Last Update Date	:	12/20/2018

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