Provider Demographics
NPI:1114180957
Name:WILLIAMS, STEVEN JOE (RN, CDE)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:JOE
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:RN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 860
Mailing Address - Street 2:
Mailing Address - City:WHITERIVER
Mailing Address - State:AZ
Mailing Address - Zip Code:85941
Mailing Address - Country:US
Mailing Address - Phone:928-338-3707
Mailing Address - Fax:
Practice Address - Street 1:400 WEST HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:WHITERIVER
Practice Address - State:AZ
Practice Address - Zip Code:85941
Practice Address - Country:US
Practice Address - Phone:928-338-3707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILCDE #2021-0497364S00000X
IL041230782163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist