Individual
STACEY WILLIAMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
4747 W 24TH AVE, GARY, IN 46406-2821
(219) 240-8615
Mailing address
4747 W 24TH AVE, GARY, IN 46406-2821
Taxonomy
Speciality
Code
Description
License number
State
163WA2000X
Administrator Registered Nurse
Primary
28235642A
IN
Other
Enumeration date
06/07/2017
Last updated
06/07/2017
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