Provider Demographics
NPI:1760608772
Name:WILLIAMS, DIANE MARIE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:MARIE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
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Mailing Address - Street 1:7110 STADIUM DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-9423
Mailing Address - Country:US
Mailing Address - Phone:269-372-7600
Mailing Address - Fax:269-372-7604
Practice Address - Street 1:7110 STADIUM DR
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-9423
Practice Address - Country:US
Practice Address - Phone:269-372-1200
Practice Address - Fax:269-353-4860
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2016-03-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704182695363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health