Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | C-APN.0003788-C-NP | CO |
NPI | 1033862149 |
---|---|
Provider Name | Marisa Elena Williams |
First Address | Anna, TX 75409-5320 |
Second Address | Aurora, CO 80045-7106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2022 |
Last Update Date | 14/02/2022 |