Provider Demographics
NPI:1598263352
Name:WILLIAMS, STEPHANIE (NP)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name: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 1:16810 S ORCHID FLOWER TRL
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:AZ
Mailing Address - Zip Code:85641-2705
Mailing Address - Country:US
Mailing Address - Phone:217-549-9887
Mailing Address - Fax:
Practice Address - Street 1:901 W REX ALLEN DR
Practice Address - Street 2:
Practice Address - City:WILLCOX
Practice Address - State:AZ
Practice Address - Zip Code:85643-1009
Practice Address - Country:US
Practice Address - Phone:520-384-3541
Practice Address - Fax:520-384-6365
Is Sole Proprietor?:No
Enumeration Date:2018-01-26
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP11241363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner