Provider Demographics
NPI:1174157556
Name:WILLIAMS, TETYANA (MSN, APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:TETYANA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:TETYANA
Other - Middle Name:
Other - Last Name:LIMONOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 519
Mailing Address - Street 2:
Mailing Address - City:LAINGSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48848-0519
Mailing Address - Country:US
Mailing Address - Phone:989-729-7779
Mailing Address - Fax:989-729-7313
Practice Address - Street 1:6980 S M 52
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-9515
Practice Address - Country:US
Practice Address - Phone:989-729-7779
Practice Address - Fax:989-729-7313
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-25
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704290197363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner