Provider Demographics
NPI:1629451596
Name:WILLIAMS, JOSEPH DANIEL (FNP)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:DANIEL
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:FNP
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 186
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49501-0186
Mailing Address - Country:US
Mailing Address - Phone:616-685-5907
Mailing Address - Fax:616-279-3164
Practice Address - Street 1:200 JEFFERSON AVE SE # I
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4502
Practice Address - Country:US
Practice Address - Phone:616-685-5907
Practice Address - Fax:616-279-3164
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08422363L00000X
MI4704341244363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAPENDINGMedicaid
LAPENDINGMedicaid