Provider Demographics
NPI:1225718182
Name:WILIAMS, FAWN NANETTE (RN ASN)
Entity Type:Individual
Prefix:
First Name:FAWN
Middle Name:NANETTE
Last Name:WILIAMS
Suffix:
Gender:F
Credentials:RN ASN
Other - Prefix:
Other - First Name:FAWN
Other - Middle Name:
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16186 NORMANDY ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-3334
Mailing Address - Country:US
Mailing Address - Phone:313-415-2545
Mailing Address - Fax:
Practice Address - Street 1:16186 NORMANDY ST
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-3334
Practice Address - Country:US
Practice Address - Phone:313-415-2545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704402553163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health