Provider Demographics
NPI:1558840173
Name:WILLIAMS, DIANE MICHELLE
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MICHELLE
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 1:990 MARLANDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-3365
Mailing Address - Country:US
Mailing Address - Phone:254-771-0852
Mailing Address - Fax:254-771-0861
Practice Address - Street 1:990 MARLANDWOOD RD
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-3365
Practice Address - Country:US
Practice Address - Phone:254-771-0852
Practice Address - Fax:254-771-0861
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX680773163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management