Provider Demographics
NPI:1629425285
Name:WILLIAMS, ALISA (RN IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:ALISA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RN IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10651 NIGGLI RD
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:IL
Mailing Address - Zip Code:62001-2609
Mailing Address - Country:US
Mailing Address - Phone:618-406-6372
Mailing Address - Fax:
Practice Address - Street 1:10651 NIGGLI RD
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:IL
Practice Address - Zip Code:62001-2609
Practice Address - Country:US
Practice Address - Phone:618-406-6372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041261299163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant