Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | 13822 | TX |
NPI | 1831654433 |
---|---|
Provider Name | Dr. Crysta Willams |
First Address | League City, TX 77573-2074 |
Second Address | La Porte, TX 77571-6018 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2019 |
Last Update Date | 07/02/2019 |