Provider Demographics
NPI:1952912370
Name:WILLIAMS, TAMELA RAY MARIE (RN)
Entity Type:Individual
Prefix:MS
First Name:TAMELA
Middle Name:RAY MARIE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 S MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:CO
Mailing Address - Zip Code:81052
Mailing Address - Country:US
Mailing Address - Phone:719-336-8721
Mailing Address - Fax:719-336-9763
Practice Address - Street 1:1001 S MAIN STREET
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:CO
Practice Address - Zip Code:81052
Practice Address - Country:US
Practice Address - Phone:719-336-8721
Practice Address - Fax:719-336-9763
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN1651184163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse