Provider Demographics
NPI:1043650492
Name:WILLIAMS, LAJUNE NICOLE (CSFA, LSA)
Entity Type:Individual
Prefix:MRS
First Name:LAJUNE
Middle Name:NICOLE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CSFA, LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2576
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-1815
Mailing Address - Country:US
Mailing Address - Phone:512-938-2664
Mailing Address - Fax:
Practice Address - Street 1:206 JAMES ADKINS DR
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-4230
Practice Address - Country:US
Practice Address - Phone:512-938-2664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-30
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX142056246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant