Individual
JENNIFER MICHELLE WILLIAMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
2355 HIGHWAY 36 W STE 100, ROSEVILLE, MN 55113-3905
(651) 292-2000
(952) 837-9701
Mailing address
2355 HIGHWAY 36 W STE 100, ROSEVILLE, MN 55113-3905
(651) 292-2000
(952) 837-9701
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
52907
MN
2085R0204X
Vascular & Interventional Radiology Physician
8810
SD
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7208750
—
SD
01
—
P01214939
RR MEDICARE
SD
Enumeration date
08/11/2007
Last updated
07/21/2022
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