Provider Demographics
NPI:1598489486
Name:WILLIAMS, NANETTE (LMT, LE)
Entity Type:Individual
Prefix:MISS
First Name:NANETTE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LMT, LE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7260 UNIVERSITY AVE NE STE 110
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-3137
Mailing Address - Country:US
Mailing Address - Phone:651-760-8351
Mailing Address - Fax:
Practice Address - Street 1:7260 UNIVERSITY AVE NE STE 110
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-3137
Practice Address - Country:US
Practice Address - Phone:651-760-8351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN173C00000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No173C00000XOther Service ProvidersReflexologist