Provider Demographics
NPI:1770942062
Name:WILLIAMS, CAROL JEAN (RN)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:JEAN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:JEAN
Other - Last Name:CONLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:5555 N. 51ST BLVD.
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218
Mailing Address - Country:US
Mailing Address - Phone:414-527-6940
Mailing Address - Fax:414-527-6941
Practice Address - Street 1:5555 N. 51ST BLVD.
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218
Practice Address - Country:US
Practice Address - Phone:414-527-6940
Practice Address - Fax:414-527-6941
Is Sole Proprietor?:No
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI95432-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse