Provider Demographics
NPI:1710667464
Name:WILLIAMS, PINKY
Entity Type:Individual
Prefix:
First Name:PINKY
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8050 N 19TH AVE # 101
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-5101
Mailing Address - Country:US
Mailing Address - Phone:480-453-1727
Mailing Address - Fax:
Practice Address - Street 1:14050 N 83RD AVE STE 106
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-5638
Practice Address - Country:US
Practice Address - Phone:800-775-5715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker