Provider Demographics
NPI:1063844850
Name:WILLIAMS, MARY JANE' (BS)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JANE'
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2108 TWIN OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:KEMAH
Mailing Address - State:TX
Mailing Address - Zip Code:77565-2151
Mailing Address - Country:US
Mailing Address - Phone:832-340-5837
Mailing Address - Fax:281-535-9532
Practice Address - Street 1:2108 TWIN OAKS BLVD
Practice Address - Street 2:
Practice Address - City:KEMAH
Practice Address - State:TX
Practice Address - Zip Code:77565-2151
Practice Address - Country:US
Practice Address - Phone:832-340-5837
Practice Address - Fax:281-535-9532
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor