Provider Demographics
NPI:1578975868
Name:WILLIAMS, LATRICIA (RN)
Entity Type:Individual
Prefix:
First Name:LATRICIA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 3RD ST
Mailing Address - Street 2:
Mailing Address - City:NAVASOTA
Mailing Address - State:TX
Mailing Address - Zip Code:77868
Mailing Address - Country:US
Mailing Address - Phone:281-224-1118
Mailing Address - Fax:
Practice Address - Street 1:303 3RD ST
Practice Address - Street 2:
Practice Address - City:NAVASOTA
Practice Address - State:TX
Practice Address - Zip Code:77868
Practice Address - Country:US
Practice Address - Phone:281-224-1118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX768652163W00000X, 163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0400XNursing Service ProvidersRegistered NurseRehabilitation
No163W00000XNursing Service ProvidersRegistered Nurse