Provider Demographics
NPI:1649785510
Name:WILLIAMS, MARIA ELENA (RN, IBCLC)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:ELENA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1755 27TH AVE.
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122
Mailing Address - Country:US
Mailing Address - Phone:612-868-4160
Mailing Address - Fax:
Practice Address - Street 1:1755 27TH AVE.
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122
Practice Address - Country:US
Practice Address - Phone:612-868-4160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-13
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA808885163W00000X
CAL-86709163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant