1447983499 NPI number — LIONEL DUKANE WILLIAMS

Table of content: LIONEL DUKANE WILLIAMS (NPI 1447983499)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447983499 NPI number — LIONEL DUKANE WILLIAMS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
LIONEL
Provider Middle Name:
DUKANE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1447983499
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 86537
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85754-6537
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-721-1887
Provider Business Mailing Address Fax Number:
520-407-5398

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35864 W MARIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARICOPA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85138-2198
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-560-3468
Provider Business Practice Location Address Fax Number:
520-407-5398
Provider Enumeration Date:
07/07/2022

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: 171W00000X , with the licence number:  11553228 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 11553228 . This is a "THERAPEUTIC FOSTER CARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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