Provider Demographics
NPI:1639380447
Name:WILLIAMS, SANDRA K (APN)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:K
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23340
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63156-3340
Mailing Address - Country:US
Mailing Address - Phone:314-517-4832
Mailing Address - Fax:
Practice Address - Street 1:12655 OLIVE BLVD
Practice Address - Street 2:4TH FLOOR
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6362
Practice Address - Country:US
Practice Address - Phone:314-517-4832
Practice Address - Fax:314-851-4445
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO061769163WC0400X, 363LA2200X
IL209-004555363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO124510013Medicare PIN