Provider Demographics
NPI:1528199726
Name:WILLIAMS, VALJA JEAN (RN, SN)
Entity Type:Individual
Prefix:MS
First Name:VALJA
Middle Name:JEAN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RN, SN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 W. BATEMAN COURT,
Mailing Address - Street 2:
Mailing Address - City:COLORADO CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86021-1196
Mailing Address - Country:US
Mailing Address - Phone:928-875-8260
Mailing Address - Fax:
Practice Address - Street 1:255 N. COTTONWOOD ST.
Practice Address - Street 2:
Practice Address - City:COLORADO CITY
Practice Address - State:AZ
Practice Address - Zip Code:86021-0309
Practice Address - Country:US
Practice Address - Phone:928-875-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN090955163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ751314Medicaid