Provider Demographics
NPI:1023400272
Name:WOMEN'S FUNCTIONAL HEALTH AND HORMONE CE
Entity Type:Organization
Organization Name:WOMEN'S FUNCTIONAL HEALTH AND HORMONE CE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SONJA
Authorized Official - Middle Name:GAYLE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:573-693-1516
Mailing Address - Street 1:1055 OZARK CARE DR
Mailing Address - Street 2:
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-3016
Mailing Address - Country:US
Mailing Address - Phone:573-693-1516
Mailing Address - Fax:573-693-1519
Practice Address - Street 1:1055 OZARK CARE DR
Practice Address - Street 2:
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-3016
Practice Address - Country:US
Practice Address - Phone:573-693-1516
Practice Address - Fax:573-693-1519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-25
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005000798174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty