Provider Demographics
NPI:1750925145
Name:WILLIAMS, NORA ELLEN
Entity type:Individual
Prefix:
First Name:NORA
Middle Name:ELLEN
Last Name:WILLIAMS
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 1:11600 WICKS LAKE RD SW
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98367-9229
Mailing Address - Country:US
Mailing Address - Phone:360-981-8313
Mailing Address - Fax:
Practice Address - Street 1:3312 ROSEDALE ST STE 105
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1809
Practice Address - Country:US
Practice Address - Phone:360-981-8313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60882767225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60882767OtherMASSAGE LICENSE NUMBER