Provider Demographics
NPI:1194385732
Name:WILLIAMS, JOSHUA VAN (AG-CNS)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:VAN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:AG-CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13343 CHERRY CIR
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80241-1529
Mailing Address - Country:US
Mailing Address - Phone:318-547-3489
Mailing Address - Fax:
Practice Address - Street 1:13343 CHERRY CIR
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80241-1529
Practice Address - Country:US
Practice Address - Phone:318-547-3489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN118818364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LARN118818OtherLOUISIANA STATE BOARD OF NURSING