1386607620 NPI number — MS. LINDA LORRAINE WILLIAMS NP

Table of content: MS. LINDA LORRAINE WILLIAMS NP (NPI 1386607620)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386607620 NPI number — MS. LINDA LORRAINE WILLIAMS NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
LINDA
Provider Middle Name:
LORRAINE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILLIAMS-MITCHAM
Provider Other First Name:
LINDA
Provider Other Middle Name:
LORRAINE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1386607620
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3912 MOONSHINE FALLS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89085-4487
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-586-5760
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4771 W CRAIG RD
Provider Second Line Business Practice Location Address:
TAKE CARE HEALTH SYSTEMS
Provider Business Practice Location Address City Name:
NORTH LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-250-8641
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/08/2006

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: 363LF0000X , with the licence number:  0024164799 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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