Provider Demographics
NPI:1922339449
Name:WILLIAMS, NINA (MT(ASCP))
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MT(ASCP)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 HILLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-9336
Mailing Address - Country:US
Mailing Address - Phone:307-856-9281
Mailing Address - Fax:307-857-2898
Practice Address - Street 1:BLACK COAL RD BLDG 29
Practice Address - Street 2:
Practice Address - City:FT WASHAKIE
Practice Address - State:WY
Practice Address - Zip Code:82514
Practice Address - Country:US
Practice Address - Phone:307-332-7672
Practice Address - Fax:307-332-7514
Is Sole Proprietor?:No
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYMT 109011246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist