Provider Demographics
NPI:1164619755
Name:WILLIAMSON, ROXANNA J (LMT)
Entity Type:Individual
Prefix:
First Name:ROXANNA
Middle Name:J
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 W 10TH ST STE 109
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-5300
Mailing Address - Country:US
Mailing Address - Phone:970-652-7425
Mailing Address - Fax:
Practice Address - Street 1:3011 W 10TH ST STE 109
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-5300
Practice Address - Country:US
Practice Address - Phone:970-652-7425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-27
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0018692174400000X
GAMT001833174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist