Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 201101170 | NC |
Y | 207Q00000X | Family Doctor | D0079494 | MD |
NPI | 1003077538 |
---|---|
Provider Name | Emma Rebecca Williams |
First Address | Bowie, MD 20715-4329 |
Second Address | Bowie, MD 20715-4329 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2008 |
Last Update Date | 08/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
86480U | UPIN (01) | NC |