Provider Demographics
NPI:1659459121
Name:WILLIAMS, MARY MARGARET (RN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MARGARET
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 ROUNDTREE CT
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-2851
Mailing Address - Country:US
Mailing Address - Phone:916-393-0568
Mailing Address - Fax:
Practice Address - Street 1:219 ESTATES DR
Practice Address - Street 2:STE #101
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-2391
Practice Address - Country:US
Practice Address - Phone:916-784-3555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA200960163W00000X
CAP249163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health