Provider Demographics
NPI:1679946230
Name:WILLIAMS, MARA BATZLI (APRN)
Entity type:Individual
Prefix:
First Name:MARA
Middle Name:BATZLI
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MARA
Other - Middle Name:ELISE
Other - Last Name:BATZLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:7816 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-4306
Mailing Address - Country:US
Mailing Address - Phone:612-968-9419
Mailing Address - Fax:
Practice Address - Street 1:671 VANDALIA ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1312
Practice Address - Country:US
Practice Address - Phone:612-968-9419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-04
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP4299363LW0102X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health