Provider Demographics
NPI:1316593445
Name:WILLIAMS, NIKHIA C (APN)
Entity Type:Individual
Prefix:
First Name:NIKHIA
Middle Name:C
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:NIKHIA
Other - Middle Name:C
Other - Last Name:LANHARDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:435 MAXINE DR SUITE 4
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-2498
Mailing Address - Country:US
Mailing Address - Phone:309-263-2424
Mailing Address - Fax:309-284-2244
Practice Address - Street 1:435 MAXINE DR SUITE 4
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550-2498
Practice Address - Country:US
Practice Address - Phone:309-263-2424
Practice Address - Fax:309-284-2244
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209019050363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner