Provider Demographics
NPI:1609451921
Name:DIMERY-WILLIAMS, MARY M
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:DIMERY-WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:M
Other - Last Name:NYAGAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3551 BLOOMFIELD LN
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-5054
Mailing Address - Country:US
Mailing Address - Phone:559-474-9218
Mailing Address - Fax:
Practice Address - Street 1:3551 BLOOMFIELD LN
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93619-5054
Practice Address - Country:US
Practice Address - Phone:559-474-9218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA719236163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse