Provider Demographics
NPI:1679307490
Name:WILLIAMS, ALYSSA MARIE (RN BSN)
Entity type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:MARIE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:MS
Other - First Name:ALYSSA
Other - Middle Name:MARIE
Other - Last Name:ZIMMERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2812 W 5600 S APT 1
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067-1227
Mailing Address - Country:US
Mailing Address - Phone:385-244-6859
Mailing Address - Fax:
Practice Address - Street 1:3673 W 5600 S
Practice Address - Street 2:
Practice Address - City:ROY
Practice Address - State:UT
Practice Address - Zip Code:84067-9389
Practice Address - Country:US
Practice Address - Phone:801-210-8119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13398323-3101164W00000X
UT13398323-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse