MEDICARE: AMELIA MCCAIN WILLIAMS CRNA

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	367500000X	Certified Registered Nurse Anesthetist	02057215	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	028159	OTHER		AANA

General Provider Information

NPI Number	:	1750339347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMELIA MCCAIN WILLIAMS CRNA

Provider Business Mailing Address
First Line	:	15655 91ST AVE
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63034-2148
Country	:	US
Telephone Number	:	314-830-2674
Fax Number	:

Provider Business Practice Location Address
First Line	:	15655 91ST AVE
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63034-2148
Country	:	US
Telephone Number	:	314-830-2674
Fax Number	:

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

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	07/08/2007

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