Provider Demographics
NPI:1710730247
Name:WILLIAMS, PHYLLIS KAYE
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:KAYE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4526 MOORE ST
Mailing Address - Street 2:
Mailing Address - City:INKSTER
Mailing Address - State:MI
Mailing Address - Zip Code:48141-3055
Mailing Address - Country:US
Mailing Address - Phone:248-242-3182
Mailing Address - Fax:
Practice Address - Street 1:4526 MOORE ST
Practice Address - Street 2:
Practice Address - City:INKSTER
Practice Address - State:MI
Practice Address - Zip Code:48141-3055
Practice Address - Country:US
Practice Address - Phone:248-242-3182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-05
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider