Provider Demographics
NPI:1730236670
Name:WILLIAMS, MARTHA MARGARITA (CPNP)
Entity type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:MARGARITA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 87
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78291-0087
Mailing Address - Country:US
Mailing Address - Phone:210-358-9174
Mailing Address - Fax:210-358-5753
Practice Address - Street 1:630 S GENERAL MCMULLEN DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78237-2005
Practice Address - Country:US
Practice Address - Phone:210-644-8500
Practice Address - Fax:210-644-8507
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX504915363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX062640003Medicaid
TX062640003Medicaid