Provider Demographics
NPI:1578174405
Name:WILLIAMS, DAI RENEE
Entity Type:Individual
Prefix:
First Name:DAI
Middle Name:RENEE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DAI
Other - Middle Name:RENEE
Other - Last Name:HODGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MAIDEN LAST NAME
Mailing Address - Street 1:4770 TEEL PKWY
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-2656
Mailing Address - Country:US
Mailing Address - Phone:972-674-0592
Mailing Address - Fax:
Practice Address - Street 1:4770 TEEL PKWY
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-2656
Practice Address - Country:US
Practice Address - Phone:972-674-0592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide