Provider Demographics
NPI:1750339347
Name:WILLIAMS, AMELIA MCCAIN (CRNA)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:MCCAIN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:AMELIA
Other - Middle Name:
Other - Last Name:MCCAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15655 91ST AVE
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63034-2148
Mailing Address - Country:US
Mailing Address - Phone:314-830-2674
Mailing Address - Fax:
Practice Address - Street 1:15655 91ST AVE
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63034-2148
Practice Address - Country:US
Practice Address - Phone:314-830-2674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO02057215367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
028159OtherAANA