Provider Demographics
NPI:1619093887
Name:WILLIAMS, CAROLYN RENEE
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:RENEE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CAROLYN
Other - Middle Name:RENEE
Other - Last Name:SHERROCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:243 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-3342
Mailing Address - Country:US
Mailing Address - Phone:937-390-1507
Mailing Address - Fax:
Practice Address - Street 1:243 E 3RD ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-3342
Practice Address - Country:US
Practice Address - Phone:937-390-1507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant