Provider Demographics
NPI:1205173465
Name:WILLIAMS, ROSE M (CNM,ANP)
Entity type:Individual
Prefix:MS
First Name:ROSE
Middle Name:M
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CNM,ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10425 E BRADLEY LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-8205
Mailing Address - Country:US
Mailing Address - Phone:907-746-4005
Mailing Address - Fax:
Practice Address - Street 1:10425 E BRADLEY LAKE AVE
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-8205
Practice Address - Country:US
Practice Address - Phone:907-746-4005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK820367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife