Provider Demographics
NPI:1073302147
Name:WILLIAMS, RONNESE
Entity type:Individual
Prefix:
First Name:RONNESE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-2540
Mailing Address - Country:US
Mailing Address - Phone:920-873-0998
Mailing Address - Fax:
Practice Address - Street 1:1200 13TH AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-2540
Practice Address - Country:US
Practice Address - Phone:920-873-0998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NA372600000X, 374U00000X
WINA372600000X, 376K00000X, 163W00000X, 171000000X, 364SH0200X, 164W00000X, 364SR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide
No171000000XOther Service ProvidersMilitary Health Care Provider
No364SH0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHome Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No364SR0400XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistRehabilitation