Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | RNP263407 | AZ |
NPI | 1023786225 |
---|---|
Provider Name | Mark Allen Williams |
First Address | Gilbert, AZ 85298-0145 |
Second Address | Gilbert, AZ 85298-0145 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2021 |
Last Update Date | 01/09/2021 |