Provider Demographics
NPI:1639118573
Name:WILLIAMS, HEATHER (CRNA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10544 COOPER RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49272-9750
Mailing Address - Country:US
Mailing Address - Phone:517-769-6421
Mailing Address - Fax:
Practice Address - Street 1:10544 COOPER RD
Practice Address - Street 2:
Practice Address - City:PLEASANT LAKE
Practice Address - State:MI
Practice Address - Zip Code:49272-9750
Practice Address - Country:US
Practice Address - Phone:517-769-6421
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704165897367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4865384Medicaid