Provider Demographics
NPI:1245521095
Name:MCWILLIAMS, SUSAN ELAINE (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELAINE
Last Name:MCWILLIAMS
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16888 DIGBY DR
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-8522
Mailing Address - Country:US
Mailing Address - Phone:479-524-4172
Mailing Address - Fax:
Practice Address - Street 1:16888 DIGBY DR
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-8522
Practice Address - Country:US
Practice Address - Phone:479-524-4172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR41814163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant