Provider Demographics
NPI:1689108698
Name:WILLIAMS, SHELLEY JUNE (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:JUNE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4281 SW EMERALD AVE
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-8630
Mailing Address - Country:US
Mailing Address - Phone:540-931-2562
Mailing Address - Fax:
Practice Address - Street 1:4281 SW EMERALD AVE
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97080-8630
Practice Address - Country:US
Practice Address - Phone:540-931-2562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-17
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201607047RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse