Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist |
NPI | 1215450002 |
---|---|
Provider Name | Patricia Denise Williams |
First Address | Richmond, TX 77406 |
Second Address | Richmond, TX 77406-7852 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2017 |
Last Update Date | 24/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
GMR00107779 | MEDICAL RADIOLOGY TECHNOLOGIST (01) | TX |