Provider Demographics
NPI:1679759278
Name:WILLIAMS, DEANNE R (CNM)
Entity type:Individual
Prefix:MS
First Name:DEANNE
Middle Name:R
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5121 S COTTONWOOD STREET
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84157-7000
Mailing Address - Country:US
Mailing Address - Phone:801-634-2114
Mailing Address - Fax:
Practice Address - Street 1:5121 S COTTONWOOD STREET
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84157-7000
Practice Address - Country:US
Practice Address - Phone:801-634-2114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1993124402367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife