Provider Demographics
NPI:1114615770
Name:WILLIAMS, ANNIE T
Entity Type:Individual
Prefix:MS
First Name:ANNIE
Middle Name:T
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18320 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-3014
Mailing Address - Country:US
Mailing Address - Phone:708-438-1915
Mailing Address - Fax:
Practice Address - Street 1:18320 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-3014
Practice Address - Country:US
Practice Address - Phone:708-438-1915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide