Provider Demographics
NPI:1770233280
Name:WILLIAMS, OLIVIA INEZ
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:INEZ
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 1:4626 N 16TH ST APT 1138
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-5134
Mailing Address - Country:US
Mailing Address - Phone:703-598-0974
Mailing Address - Fax:
Practice Address - Street 1:4626 N 16TH ST APT 1138
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-5134
Practice Address - Country:US
Practice Address - Phone:703-598-0974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-27
Last Update Date:2022-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program