Provider Demographics
NPI:1215458781
Name:WILLIAMS, DEIDRA DIANE (CNM)
Entity type:Individual
Prefix:MRS
First Name:DEIDRA
Middle Name:DIANE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CNM
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Mailing Address - Street 1:26901 BEAUMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:947-522-1848
Mailing Address - Fax:947-522-0307
Practice Address - Street 1:3601 W 13 MILE RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6712
Practice Address - Country:US
Practice Address - Phone:248-898-4021
Practice Address - Fax:248-898-1473
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2021-11-05
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Provider Licenses
StateLicense IDTaxonomies
MI4704294411367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife