1609098979 NPI number — MR. AVERY LA-MONT WILLIAMS REGISTERED NURSE

Table of content: KARIE LUKAS-LEDUC LICSW (NPI 1346454022)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609098979 NPI number — MR. AVERY LA-MONT WILLIAMS REGISTERED NURSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
AVERY
Provider Middle Name:
LA-MONT
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
REGISTERED NURSE
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609098979
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3029 HILLSIDE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEL CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73115-1847
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-278-1573
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3029 HILLSIDE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEL CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73115-1847
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-278-1573
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WA0400X , with the licence number:  R0070988 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com