Provider Demographics
NPI:1073810206
Name:WILLIAMS, DAMION DARYL ST CLAIR (LPN)
Entity Type:Individual
Prefix:MR
First Name:DAMION
Middle Name:DARYL ST CLAIR
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4031 DE REIMER AVE.
Mailing Address - Street 2:PH
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-2320
Mailing Address - Country:US
Mailing Address - Phone:352-328-2117
Mailing Address - Fax:
Practice Address - Street 1:4031 DE REIMER AVE
Practice Address - Street 2:PH
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-2320
Practice Address - Country:US
Practice Address - Phone:352-328-2117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302978-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse