Provider Demographics
NPI:1326825126
Name:WILLIAMS, ANAISE
Entity Type:Individual
Prefix:
First Name:ANAISE
Middle Name:
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 1:40 EMERALD PINES CT APT 12
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-6544
Mailing Address - Country:US
Mailing Address - Phone:773-964-8831
Mailing Address - Fax:
Practice Address - Street 1:40 EMERALD PINES CT APT 12
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-6544
Practice Address - Country:US
Practice Address - Phone:773-964-8831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor