Provider Demographics
NPI:1972628758
Name:WILLIAMS, MARCY L
Entity type:Individual
Prefix:
First Name:MARCY
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARCY
Other - Middle Name:L
Other - Last Name:BLANCETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5194
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88062-5194
Mailing Address - Country:US
Mailing Address - Phone:505-534-0884
Mailing Address - Fax:
Practice Address - Street 1:2810 N SWAN ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-5853
Practice Address - Country:US
Practice Address - Phone:505-956-2000
Practice Address - Fax:505-956-2055
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR51470163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse