Provider Demographics
NPI:1053635052
Name:WILLIAMS, DEONNE IRENE (NNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:DEONNE
Middle Name:IRENE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:NNP-BC
Other - Prefix:MS
Other - First Name:DEONNE
Other - Middle Name:IRENE
Other - Last Name:THIBODEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:43 WHITING HILL RD STE 300
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1006
Mailing Address - Country:US
Mailing Address - Phone:207-973-8670
Mailing Address - Fax:
Practice Address - Street 1:489 STATE ST
Practice Address - Street 2:NICU PROFESSIONAL SERVICES
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6616
Practice Address - Country:US
Practice Address - Phone:207-973-8670
Practice Address - Fax:207-973-5163
Is Sole Proprietor?:No
Enumeration Date:2010-03-19
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP101003363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal