Basic Information
| Provider Information | |||||||||
| NPI: | 1346484805 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMSON | ||||||||
| FirstName: | RACHONN | ||||||||
| MiddleName: | SHALETTE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | IDMT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 243 CURTISS RD | ||||||||
| Address2: | 2 AMDS/SGPF (SUITE 100) | ||||||||
| City: | BARKSDALE AFB | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711102425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184566418 | ||||||||
| FaxNumber: | 3184568065 | ||||||||
| Practice Location | |||||||||
| Address1: | 243 CURTISS RD | ||||||||
| Address2: | ST 100 (2AMDS/SGPF) | ||||||||
| City: | BARKSDALE AFB | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711102425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184566418 | ||||||||
| FaxNumber: | 3184568065 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2009 | ||||||||
| LastUpdateDate: | 04/30/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1710I1003X | Y | Other Service Providers | Military Health Care Provider | Independent Duty Medical Technicians |
No ID Information.