Provider Demographics
NPI:1720651623
Name:WILLIAMSON, PATRICIA WILLIAMSON ANN
Entity Type:Individual
Prefix:
First Name:PATRICIA WILLIAMSON
Middle Name:ANN
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 S LACLEDE STATION RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-4911
Mailing Address - Country:US
Mailing Address - Phone:314-446-2486
Mailing Address - Fax:314-446-2447
Practice Address - Street 1:723 S LACLEDE STATION RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-4911
Practice Address - Country:US
Practice Address - Phone:314-446-2486
Practice Address - Fax:314-446-2447
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001017769163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice