Provider Demographics
NPI:1972803013
Name:WILLIAMS, MARY ELLEN (NP-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELLEN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 E A ST
Mailing Address - Street 2:S 101
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2276
Mailing Address - Country:US
Mailing Address - Phone:307-577-8600
Mailing Address - Fax:307-577-8605
Practice Address - Street 1:1416 E A ST
Practice Address - Street 2:S 101
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2276
Practice Address - Country:US
Practice Address - Phone:307-577-8600
Practice Address - Fax:307-577-8605
Is Sole Proprietor?:No
Enumeration Date:2010-10-22
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY8993-1079363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner