Provider Demographics
NPI:1275000903
Name:WILLIAMS, PATRICE R
Entity Type:Individual
Prefix:
First Name:PATRICE
Middle Name:R
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 1:1755 N PEBBLE CREEK PKWY # 1220
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2532
Mailing Address - Country:US
Mailing Address - Phone:480-382-4445
Mailing Address - Fax:
Practice Address - Street 1:2737 W SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-4244
Practice Address - Country:US
Practice Address - Phone:480-382-4445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-31
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator