Provider Demographics
NPI:1760818041
Name:WILLIAMS, MICHELLE LOUISE (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LOUISE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 POPLAR ST STE 110
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-3081
Mailing Address - Country:US
Mailing Address - Phone:814-373-3070
Mailing Address - Fax:814-373-3074
Practice Address - Street 1:505 POPLAR ST STE 110
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3081
Practice Address - Country:US
Practice Address - Phone:814-373-3070
Practice Address - Fax:814-373-3074
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMAO56398363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103198625Medicaid