Provider Demographics
NPI:1710508239
Name:WILLIAMS, VIVIAN DANIELLE (LPN)
Entity Type:Individual
Prefix:MS
First Name:VIVIAN
Middle Name:DANIELLE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 N MONTICELLO AVE # 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60651-3949
Mailing Address - Country:US
Mailing Address - Phone:773-739-4440
Mailing Address - Fax:
Practice Address - Street 1:940 N MONTICELLO AVE # 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60651-3949
Practice Address - Country:US
Practice Address - Phone:773-739-4440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier