Basic Information
Provider Information
NPI: 1255573531
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WILLIAMSON
FirstName: TEREHAS
MiddleName: DAWN LINDO
NamePrefix: MRS.
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2080 SW 117TH AVE
Address2:  
City: MIRAMAR
State: FL
PostalCode: 330255651
CountryCode: US
TelephoneNumber: 9546828287
FaxNumber:  
Practice Location
Address1: 1611 NW 12TH AVE
Address2:  
City: MIAMI
State: FL
PostalCode: 331361005
CountryCode: US
TelephoneNumber: 3055856586
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/01/2009
LastUpdateDate: 10/22/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000XARNP9220278FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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