Provider Demographics
NPI:1659625879
Name:WILLIAMS, CHARLES IOKEPA (NP-C)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:IOKEPA
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1660 HIGHWAY 100 SOUTH
Mailing Address - Street 2:SUITE 145
Mailing Address - City:ST. LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1562
Mailing Address - Country:US
Mailing Address - Phone:952-456-6160
Mailing Address - Fax:952-456-6184
Practice Address - Street 1:1660 HWY 100 SOUTH
Practice Address - Street 2:SUITE 145
Practice Address - City:ST. LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1562
Practice Address - Country:US
Practice Address - Phone:952-456-6160
Practice Address - Fax:952-456-6184
Is Sole Proprietor?:No
Enumeration Date:2012-11-09
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN166936-9363LA2200X
MNR166936-9363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN500008394OtherMEDICAL PTAN
MNC09271OtherMEDICARE GROUP PTAN