Provider Demographics
NPI:1245376839
Name:WILLIAMS, MARIE BERTON (CRNFA)
Entity type:Individual
Prefix:MS
First Name:MARIE
Middle Name:BERTON
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CRNFA
Other - Prefix:MS
Other - First Name:MARIE
Other - Middle Name:LOUISE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNFA
Mailing Address - Street 1:130 RODEO RD
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-7928
Mailing Address - Country:US
Mailing Address - Phone:386-677-0762
Mailing Address - Fax:386-677-0762
Practice Address - Street 1:130 RODEO RD
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-7928
Practice Address - Country:US
Practice Address - Phone:386-677-0762
Practice Address - Fax:386-677-0762
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL89722-2163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant