Provider Demographics
NPI:1336476852
Name:WILLIAMS, NIKKI E (LPN)
Entity Type:Individual
Prefix:MR
First Name:NIKKI
Middle Name:E
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19528 83RD STREET
Mailing Address - Street 2:TWNHSE 7
Mailing Address - City:BRISTOL
Mailing Address - State:WI
Mailing Address - Zip Code:53104
Mailing Address - Country:US
Mailing Address - Phone:262-891-3215
Mailing Address - Fax:
Practice Address - Street 1:19528 83RD ST #7
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:WI
Practice Address - Zip Code:53104
Practice Address - Country:US
Practice Address - Phone:262-891-3215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI311415-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse