Provider Demographics
NPI:1497214597
Name:WILLIAMS, JOSHUA (LPN)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
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 1:6543 SAN MIGUEL WAY
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-3772
Mailing Address - Country:US
Mailing Address - Phone:210-861-0811
Mailing Address - Fax:
Practice Address - Street 1:8618 LUDLOW CV
Practice Address - Street 2:
Practice Address - City:CONVERSE
Practice Address - State:TX
Practice Address - Zip Code:78109-3672
Practice Address - Country:US
Practice Address - Phone:210-861-0811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212525164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse