Provider Demographics
NPI:1942774211
Name:WILLIAMS, NICOLE M (RRT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3021 RIDGE RD STE 107
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-5830
Mailing Address - Country:US
Mailing Address - Phone:469-338-7501
Mailing Address - Fax:
Practice Address - Street 1:3021 RIDGE RD STE 107
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-5830
Practice Address - Country:US
Practice Address - Phone:469-338-7501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered