Provider Demographics
NPI:1124399100
Name:WILLIAMS, AMY JO (RN)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:JO
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:JO
Other - Last Name:BARUTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:8235 137TH AVE
Mailing Address - Street 2:
Mailing Address - City:BECKER
Mailing Address - State:MN
Mailing Address - Zip Code:55308-4683
Mailing Address - Country:US
Mailing Address - Phone:763-262-9795
Mailing Address - Fax:
Practice Address - Street 1:4801 VETERANS DR
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-2015
Practice Address - Country:US
Practice Address - Phone:320-252-1670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1692158163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical