Provider Demographics
NPI:1205281987
Name:WILLLIAMS, BLANE P (ND)
Entity type:Individual
Prefix:DR
First Name:BLANE
Middle Name:P
Last Name:WILLLIAMS
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 MCKAYS CT
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-2932
Mailing Address - Country:US
Mailing Address - Phone:502-297-2946
Mailing Address - Fax:
Practice Address - Street 1:411 MCKAYS CT
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-2932
Practice Address - Country:US
Practice Address - Phone:502-297-2946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-29
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT099.0000158175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath