Individual
MR. CHARLES IOKEPA WILLIAMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP-C
Contact information
Practice address
1660 HWY 100 SOUTH, SUITE 145, ST. LOUIS PARK, MN 55416-1562
(952) 456-6160
(952) 456-6184
Mailing address
1660 HIGHWAY 100 SOUTH, SUITE 145, ST. LOUIS PARK, MN 55416-1562
(952) 456-6160
(952) 456-6184
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
166936-9
MN
363LA2200X
Adult Health Nurse Practitioner
Primary
R166936-9
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
500008394
MEDICAL PTAN
MN
01
—
C09271
MEDICARE GROUP PTAN
MN
Enumeration date
11/09/2012
Last updated
04/19/2013
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