Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | AP141120 | TX |
N | 363LA2200X | Nurse Practitioner - Adult Health | AP141120 | TX |
N | 363LC1500X | Nurse Practitioner - Community Health | AP141120 | TX |
N | 363LP2300X | Nurse Practitioner - Primary Care | AP141120 | TX |
NPI | 1649732447 |
---|---|
Provider Name | Larissa Ann Williams |
First Address | Houston, TX 77044-4478 |
Second Address | Houston, TX 77044-4478 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2019 |
Last Update Date | 02/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NONE | NONE (01) |