Provider Demographics
NPI:1801036926
Name:WILLIAMS, EMILY JANE
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:JANE
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 1:11708 SINCLAIR DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46235-6016
Mailing Address - Country:US
Mailing Address - Phone:317-826-9302
Mailing Address - Fax:
Practice Address - Street 1:11708 SINCLAIR DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46235-6016
Practice Address - Country:US
Practice Address - Phone:317-826-9302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN933304174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist