Provider Demographics
NPI:1720226186
Name:WILLIAMS, LEATRICE L (LVN)
Entity Type:Individual
Prefix:MS
First Name:LEATRICE
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3840 MYERS ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3614
Mailing Address - Country:US
Mailing Address - Phone:951-358-4710
Mailing Address - Fax:951-358-4978
Practice Address - Street 1:3840 MYERS ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3614
Practice Address - Country:US
Practice Address - Phone:951-358-4710
Practice Address - Fax:951-358-4978
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN178555164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse