Provider Demographics
NPI:1922166776
Name:WILLIAMS, MARIANN (NP)
Entity Type:Individual
Prefix:
First Name:MARIANN
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 S. WESTERN AVE
Mailing Address - Street 2:C/O: CREDENTIALING
Mailing Address - City:TONASKET
Mailing Address - State:WA
Mailing Address - Zip Code:98855
Mailing Address - Country:US
Mailing Address - Phone:509-486-3191
Mailing Address - Fax:509-223-1743
Practice Address - Street 1:118 S WHITCOMB AVE
Practice Address - Street 2:
Practice Address - City:TONASKET
Practice Address - State:WA
Practice Address - Zip Code:98855-9287
Practice Address - Country:US
Practice Address - Phone:509-486-3191
Practice Address - Fax:509-223-1743
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30003589363L00000X
WARN00056504363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0306262OtherL&I
WA1922166776Medicaid
WA0306262OtherL&I
WAG8915761Medicare PIN