Provider Demographics
NPI:1093196701
Name:WILLIAMS, ELLEN BRIANNA (MD)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:BRIANNA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:ELLEN
Other - Middle Name:BRIANNA
Other - Last Name:ABELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:220 15TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372
Mailing Address - Country:US
Mailing Address - Phone:253-697-1421
Mailing Address - Fax:253-445-6520
Practice Address - Street 1:220 15TH AVE SE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372
Practice Address - Country:US
Practice Address - Phone:253-697-1421
Practice Address - Fax:253-445-6520
Is Sole Proprietor?:No
Enumeration Date:2015-06-18
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS94-08645207Q00000X
WAMD61066668207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty