Provider Demographics
NPI:1598980708
Name:WILLIAMS, SHAREE JEAN (LVN)
Entity Type:Individual
Prefix:MRS
First Name:SHAREE
Middle Name:JEAN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29221 GATEWAY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-7276
Mailing Address - Country:US
Mailing Address - Phone:951-378-1051
Mailing Address - Fax:
Practice Address - Street 1:29221 GATEWAY DR
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-7276
Practice Address - Country:US
Practice Address - Phone:951-378-1051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN195321164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse