| Doctor Name: | MR. CHARLES IOKEPA WILLIAMS |
| NPI Number: | 1659625879 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | NP-C |
| License Number: | 166936-9 |
| Business Practice Address: | 1660 Hwy 100 South Suite 145 St. Louis Park, MN - 554161562 |
| Business Phone Number: | 9524566160 |
| Business Fax Number: | 9524566184 |
| Mailing Address: | 1660 Highway 100 South, Suite 145 ST. LOUIS PARK |
| State: | MN |
| Postal Code: | 554161562 |
| Phone Number: | 9524566160 |
| Fax Number: | 9524566184 |
| NPI Enumeration Date: | 11/09/2012 |
| NPI Last Update Date: | 04/19/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 166936-9 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |