Provider Demographics
NPI:1235291089
Name:WILLIAMS, CHERYL LOU
Entity type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:LOU
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 W MEADOWLARK LN
Mailing Address - Street 2:
Mailing Address - City:CORRALES
Mailing Address - State:NM
Mailing Address - Zip Code:87048-9684
Mailing Address - Country:US
Mailing Address - Phone:505-890-0441
Mailing Address - Fax:505-727-2176
Practice Address - Street 1:10501 GOLF COURSE RD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-5019
Practice Address - Country:US
Practice Address - Phone:505-727-2212
Practice Address - Fax:505-727-2176
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM150174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist