Provider Demographics
NPI:1043436389
Name:WILLIAMS, VALERIA L (NP)
Entity type:Individual
Prefix:MS
First Name:VALERIA
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:VALERIA
Other - Middle Name:L
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP, DNP
Mailing Address - Street 1:924 UNION DR
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60466-3035
Mailing Address - Country:US
Mailing Address - Phone:708-534-0026
Mailing Address - Fax:
Practice Address - Street 1:3409 W FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-2415
Practice Address - Country:US
Practice Address - Phone:773-486-5001
Practice Address - Fax:773-486-5020
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-006290363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041-233585OtherREGISTERED NURSE
IL309-003250OtherAPN CONTROLLED SUBSTANCE
IL209-006290OtherAPN