Provider Demographics
NPI:1407328107
Name:SONNIE-WILLIAMS, MUSU OLU (NP)
Entity Type:Individual
Prefix:
First Name:MUSU
Middle Name:OLU
Last Name:SONNIE-WILLIAMS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6897 DALE HOLLOW DR SE
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49316-7815
Mailing Address - Country:US
Mailing Address - Phone:616-648-3246
Mailing Address - Fax:
Practice Address - Street 1:6897 DALE HOLLOW DR SE
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:MI
Practice Address - Zip Code:49316-7815
Practice Address - Country:US
Practice Address - Phone:616-648-3246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704215504363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI8282OtherMI - MEDICARE