Individual
DERRICK LANE WILLIAMS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN, APRN, ACNP
Contact information
Practice address
7950 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4140
(260) 203-9600
(260) 739-6167
Mailing address
10351 DAWSONS CREEK BLVD, SUITE A-1, FORT WAYNE, IN 46825-1904
(260) 203-9600
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71003104A
IN
363LA2100X
Acute Care Nurse Practitioner
28139511A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200972030
—
IN
Enumeration date
10/06/2009
Last updated
09/02/2014
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