Provider Demographics
NPI:1164153516
Name:VAN WILLIAMS, MICHAEL STEKLY
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:STEKLY
Last Name:VAN WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 PETTIS DR
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02889-8816
Mailing Address - Country:US
Mailing Address - Phone:508-505-6467
Mailing Address - Fax:
Practice Address - Street 1:90 TER HEUN DR
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-2533
Practice Address - Country:US
Practice Address - Phone:508-495-8300
Practice Address - Fax:508-495-8315
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-17
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN57571163W00000X
MARN2326870363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered Nurse