Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 2000014376 | CA |
Y | 213ES0000X | Sports Medicine | 2000014376 | CA |
NPI | 1366080111 |
---|---|
Provider Name | Julie Anne Williams |
First Address | Pueblo West, CO 81007-6311 |
Second Address | Pueblo West, CO 81007-6311 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2019 |
Last Update Date | 11/12/2019 |