Provider Demographics
NPI:1477763613
Name:WILLIAMS, JANET L (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 ROSANNA LN
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:UT
Mailing Address - Zip Code:84004-1879
Mailing Address - Country:US
Mailing Address - Phone:801-763-9786
Mailing Address - Fax:
Practice Address - Street 1:1225 FORT UNION BLVD STE 200
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-1882
Practice Address - Country:US
Practice Address - Phone:801-233-4400
Practice Address - Fax:801-233-4410
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT52725311206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT52725311206OtherSTATE LICENSE
UT52725311206OtherSTATE LICENSE