Provider Demographics
NPI:1629690813
Name:WILLIAMS, SHARIECE MONIQUE
Entity Type:Individual
Prefix:MRS
First Name:SHARIECE
Middle Name:MONIQUE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SHARIECE
Other - Middle Name:M
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BD, CBE
Mailing Address - Street 1:4606 LIME STRAIGHT DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-2129
Mailing Address - Country:US
Mailing Address - Phone:757-913-3837
Mailing Address - Fax:
Practice Address - Street 1:4606 LIME STRAIGHT DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89115-2129
Practice Address - Country:US
Practice Address - Phone:757-913-3837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-11
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor