MEDICARE: KATEMA NICOLE WILLIAMS

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	347C00000X	Private Vehicle	GH8 GOG	MO

General Provider Information

NPI Number	:	1801153291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATEMA NICOLE WILLIAMS

Provider Business Mailing Address
First Line	:	4204 W SAN FRANCISCO AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63115-2917
Country	:	US
Telephone Number	:	314-723-2626
Fax Number	:

Provider Business Practice Location Address
First Line	:	4204 W SAN FRANCISCO AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63115-2917
Country	:	US
Telephone Number	:	314-723-2626
Fax Number	:

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

Provider Enumeration Date	:	04/23/2012
Last Update Date	:	04/23/2012

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Directions to “ KATEMA NICOLE WILLIAMS ” Practice Location

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