Basic Information
| Provider Information | |||||||||
| NPI: | 1598263352 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16810 S ORCHID FLOWER TRL | ||||||||
| Address2: | |||||||||
| City: | VAIL | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856412705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2175499887 | ||||||||
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| Practice Location | |||||||||
| Address1: | 901 W REX ALLEN DR | ||||||||
| Address2: | |||||||||
| City: | WILLCOX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856431009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203843541 | ||||||||
| FaxNumber: | 5203846365 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2018 | ||||||||
| LastUpdateDate: | 08/02/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | AP11241 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.