Provider Demographics
NPI:1366012387
Name:WILLIAMSON, COLLEEN DEE
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:DEE
Last Name:WILLIAMSON
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 1:9260 219TH ST
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:SD
Mailing Address - Zip Code:57769-8114
Mailing Address - Country:US
Mailing Address - Phone:605-381-0483
Mailing Address - Fax:
Practice Address - Street 1:13263 HORSESHOE CT
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:SD
Practice Address - Zip Code:57769-7136
Practice Address - Country:US
Practice Address - Phone:605-381-0483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide