Provider Demographics
NPI:1609474626
Name:WILLIAMS-WILLIS, ANDTRIA (LVN)
Entity Type:Individual
Prefix:
First Name:ANDTRIA
Middle Name:
Last Name:WILLIAMS-WILLIS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:ANDTRIA
Other - Middle Name:LATRICE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3101 W ADAMS AVE APT 212
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504-2843
Mailing Address - Country:US
Mailing Address - Phone:254-598-1305
Mailing Address - Fax:
Practice Address - Street 1:17350 STATE HIGHWAY 249 STE 220
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77064-1132
Practice Address - Country:US
Practice Address - Phone:254-598-1305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX351982164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse