Provider Demographics
NPI:1710140652
Name:WILLIAMS, DEANNA PATRICE (LPO)
Entity Type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:PATRICE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 BUFFALO CREEK DR
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-5329
Mailing Address - Country:US
Mailing Address - Phone:972-230-2959
Mailing Address - Fax:
Practice Address - Street 1:212 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-3649
Practice Address - Country:US
Practice Address - Phone:972-298-0018
Practice Address - Fax:972-298-0019
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1169335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier