Provider Demographics
NPI:1992177729
Name:WILLIAMS, DESIREE (PA-C)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13755 N LITCHFIELD RD
Mailing Address - Street 2:#105
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-4287
Mailing Address - Country:US
Mailing Address - Phone:623-322-5900
Mailing Address - Fax:
Practice Address - Street 1:13755 N LITCHFIELD RD
Practice Address - Street 2:#105
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-4287
Practice Address - Country:US
Practice Address - Phone:623-322-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-20
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6276363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant