Provider Demographics
NPI:1093787210
Name:WILLIAMS, PANDORA (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:PANDORA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:PANDORA
Other - Middle Name:
Other - Last Name:HECTOR-LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 98978
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-8978
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:4880 WYNN RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-5406
Practice Address - Country:US
Practice Address - Phone:702-871-5005
Practice Address - Fax:702-871-1341
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1613363A00000X
NVPA1665363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ181032Medicaid
NV1093787210Medicaid
AZ181032Medicaid
AZZ128634Medicare PIN