Provider Demographics
NPI:1235524893
Name:WILLIAMS, EBBISSE Y
Entity Type:Individual
Prefix:
First Name:EBBISSE
Middle Name:Y
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7557 CARILLON PLZ W
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-1602
Mailing Address - Country:US
Mailing Address - Phone:612-423-6754
Mailing Address - Fax:651-735-6793
Practice Address - Street 1:7557 CARILLON PLZ W
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-1602
Practice Address - Country:US
Practice Address - Phone:612-423-6754
Practice Address - Fax:651-735-6793
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-31
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN343900000X343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNDONT HAVE ONEMedicare UPIN