Provider Demographics
NPI:1093578833
Name:WILLIAMS, ANGELA D (LPN)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:D
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9416 WAKASHAN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-0501
Mailing Address - Country:US
Mailing Address - Phone:702-717-2372
Mailing Address - Fax:
Practice Address - Street 1:3770 HOWARD HUGHES PKWY STE 295
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-0998
Practice Address - Country:US
Practice Address - Phone:702-369-9828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLPN17731164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse