Basic Information
| Provider Information | |||||||||
| NPI: | 1942228770 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | SETH | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | APRN,FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8200 CENTRAL AVE SE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871082408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052725855 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8200 CENTRAL AVE SE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871082408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052725885 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 10/15/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 101-0024885 | VT | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | CNP-01496 | NM | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 1010453 | 05 | VT | MEDICAID |