Provider Demographics
NPI:1538661913
Name:WILLIAMS, WANDA ARLENE
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:ARLENE
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 1:9858 ELK GROVE VALLEY ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-4804
Mailing Address - Country:US
Mailing Address - Phone:818-388-7618
Mailing Address - Fax:
Practice Address - Street 1:801 S RANCHO DR STE E2B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-3812
Practice Address - Country:US
Practice Address - Phone:702-586-2763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant