Provider Demographics
NPI:1245255637
Name:WILLIAMS, NANCY EUEGINA (APRN)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:EUEGINA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:NANETTE
Other - Middle Name:
Other - Last Name:HOLLOWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2075 S COTTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-3040
Mailing Address - Country:US
Mailing Address - Phone:480-718-0568
Mailing Address - Fax:480-307-6676
Practice Address - Street 1:2075 S COTTONWOOD DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-3040
Practice Address - Country:US
Practice Address - Phone:480-718-0568
Practice Address - Fax:480-307-6676
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAPRN3006237363LP0808X
AZRN059716363LP0808X
AZAP1252363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ555336Medicaid
AZ555336Medicaid
KYK005241OtherMEDICARE PTAN
KYK005241OtherMEDICARE PTAN
KY7100127040Medicaid