Provider Demographics
NPI:1457925042
Name:WILLIAMS, MAILYN FAYE (PA-C, RDMS, RVT)
Entity Type:Individual
Prefix:
First Name:MAILYN
Middle Name:FAYE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PA-C, RDMS, RVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17425 BETTIJEAN ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99516-5612
Mailing Address - Country:US
Mailing Address - Phone:612-250-9741
Mailing Address - Fax:
Practice Address - Street 1:4311 11TH AVE NE STE 200
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-6367
Practice Address - Country:US
Practice Address - Phone:206-616-4001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant