Provider Demographics
NPI:1669666285
Name:WILLIAMS, NOLAN RAY (APRN, BC)
Entity Type:Individual
Prefix:MR
First Name:NOLAN
Middle Name:RAY
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:APRN, BC
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:WA FOOTE MEMORIAL HOSPITAL INC PROFESSIONAL BILLING
Mailing Address - Street 2:PO BOX 67000, DEPARTMENT 272801
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-2728
Mailing Address - Country:US
Mailing Address - Phone:517-841-1328
Mailing Address - Fax:517-841-1330
Practice Address - Street 1:205 N EAST AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1753
Practice Address - Country:US
Practice Address - Phone:517-841-1328
Practice Address - Fax:517-841-1330
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704207712363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health