Provider Demographics
NPI:1114918232
Name:MCWILLIAMS, DEBORAH (RN, CPNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:MCWILLIAMS
Suffix:
Gender:F
Credentials:RN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24838 JAMESTOWNE RD
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-2278
Mailing Address - Country:US
Mailing Address - Phone:248-348-7971
Mailing Address - Fax:
Practice Address - Street 1:3901 BEAUBIEN ST
Practice Address - Street 2:DIVISION OF UROLOGY
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2119
Practice Address - Country:US
Practice Address - Phone:313-966-5371
Practice Address - Fax:313-993-8738
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704104666363LP0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4702389Medicaid
MIP41599Medicare UPIN
MI4702389Medicaid