Provider Demographics
NPI:1467811497
Name:WILLIAMS, CLAUDETTE
Entity Type:Individual
Prefix:
First Name:CLAUDETTE
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 1:18625 MUIRLAND ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-2202
Mailing Address - Country:US
Mailing Address - Phone:888-733-2054
Mailing Address - Fax:313-429-0283
Practice Address - Street 1:18625 MUIRLAND ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-2202
Practice Address - Country:US
Practice Address - Phone:888-733-2054
Practice Address - Fax:313-429-0283
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide