Provider Demographics
NPI:1356413900
Name:WILLIAMSON, PAULA FAYE (FNP)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:FAYE
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 S MICHIGAN AVE
Mailing Address - Street 2:#3005
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2776
Mailing Address - Country:US
Mailing Address - Phone:312-929-3979
Mailing Address - Fax:312-929-3979
Practice Address - Street 1:1160 S MICHIGAN AVE
Practice Address - Street 2:#3005
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2776
Practice Address - Country:US
Practice Address - Phone:312-929-3979
Practice Address - Fax:312-929-3979
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1009384363LF0000X
IL209.007395363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily