Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 53-75136-052 | KS |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 53-75136-052 | KS |
NPI | 1003127143 |
---|---|
Provider Name | Annette Diane Williamson |
First Address | Blue Springs, MO 64015-3069 |
Second Address | Kansas City, KS 66101-3042 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2010 |
Last Update Date | 09/02/2021 |