Provider Demographics
NPI:1437654951
Name:WILLIAMS, DESHAWN
Entity Type:Individual
Prefix:
First Name:DESHAWN
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4620 THOUSAND OAKS DR APT 1701
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78233-6959
Mailing Address - Country:US
Mailing Address - Phone:210-317-9086
Mailing Address - Fax:
Practice Address - Street 1:4620 THOUSAND OAKS DR APT 1701
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78233-6959
Practice Address - Country:US
Practice Address - Phone:210-317-9086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX338623164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse