Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | CNP101003 | ME |
NPI | 1053635052 |
---|---|
Provider Name | Mrs. Deonne Irene Williams |
First Address | Brewer, ME 04412-1006 |
Second Address | Bangor, ME 04401-6616 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2010 |
Last Update Date | 05/05/2020 |