Provider Demographics
NPI:1649421611
Name:WILLIAMS, JESSE ANTHONY III (LVN)
Entity Type:Individual
Prefix:MR
First Name:JESSE
Middle Name:ANTHONY
Last Name:WILLIAMS
Suffix:III
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3470 LANDREW ROAD
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92571
Mailing Address - Country:US
Mailing Address - Phone:909-376-3228
Mailing Address - Fax:
Practice Address - Street 1:3470 LANDREW RD
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-7311
Practice Address - Country:US
Practice Address - Phone:909-376-3228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 182778164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse