Basic Information
| Provider Information | |||||||||
| NPI: | 1356810808 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | BERNICE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | RN, CDE | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1577 | ||||||||
| Address2: | |||||||||
| City: | DURANT | ||||||||
| State: | OK | ||||||||
| PostalCode: | 747021577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5809202100 | ||||||||
| FaxNumber: | 5809169191 | ||||||||
| Practice Location | |||||||||
| Address1: | 1801 CHUKKA HINA | ||||||||
| Address2: | |||||||||
| City: | DURANT | ||||||||
| State: | OK | ||||||||
| PostalCode: | 747017117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5809202100 | ||||||||
| FaxNumber: | 5809169191 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2018 | ||||||||
| LastUpdateDate: | 11/14/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | R0052962 | OK | Y | Nursing Service Providers | Registered Nurse |
No ID Information.