Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1376001982 |
---|---|
Provider Name | Miss Kerryann Williams |
First Address | Margate, FL 33063-5101 |
Second Address | Margate, FL 33063-5101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2019 |
Last Update Date | 04/03/2019 |