Provider Demographics
NPI:1477691939
Name:WILLIAMSON, WALTER DOUGLAS (RN, CRNA)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:DOUGLAS
Last Name:WILLIAMSON
Suffix:
Gender:M
Credentials:RN, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15312 50TH RD
Mailing Address - Street 2:
Mailing Address - City:FRANKSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53126-9660
Mailing Address - Country:US
Mailing Address - Phone:619-955-9523
Mailing Address - Fax:
Practice Address - Street 1:3001 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064
Practice Address - Country:US
Practice Address - Phone:847-688-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA669610163W00000X
WI129682163W00000X
CA4418367500000X
WI8093-33367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse