Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081S0010X | Sports Medicine | AT788 | NM |
N | 213ES0000X | Sports Medicine | AT788 | NM |
NPI | 1336795780 |
---|---|
Provider Name | Susan J Williams |
First Address | Las Cruces, NM 88007-1950 |
Second Address | Las Cruces, NM 88001-5780 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2019 |
Last Update Date | 12/08/2019 |