Provider Demographics
NPI:1194922534
Name:WILLIAMS, KATHE M (BSN,RN,MSN)
Entity type:Individual
Prefix:
First Name:KATHE
Middle Name:M
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:BSN,RN,MSN
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 8111
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97303-0244
Mailing Address - Country:US
Mailing Address - Phone:971-388-4620
Mailing Address - Fax:503-581-3012
Practice Address - Street 1:560 19TH ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4305
Practice Address - Country:US
Practice Address - Phone:971-388-4620
Practice Address - Fax:503-581-3012
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR211452Medicaid