Provider Demographics
NPI:1407367675
Name:WILLIAMS, LYNNETTE DANA
Entity Type:Individual
Prefix:
First Name:LYNNETTE
Middle Name:DANA
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 1:2701 BRUCE PL SE APT 13
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-3260
Mailing Address - Country:US
Mailing Address - Phone:202-290-4291
Mailing Address - Fax:
Practice Address - Street 1:2629 STANTON RD SE APT 303
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-4477
Practice Address - Country:US
Practice Address - Phone:202-290-4291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant