Provider Demographics
NPI:1336267830
Name:WILLIAMS, CLIFFORD MONDELL (RN)
Entity Type:Individual
Prefix:MR
First Name:CLIFFORD
Middle Name:MONDELL
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14301 SWAN LN
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-8406
Mailing Address - Country:US
Mailing Address - Phone:228-669-3818
Mailing Address - Fax:
Practice Address - Street 1:14301 SWAN LN
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-8406
Practice Address - Country:US
Practice Address - Phone:228-669-3818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR873946163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse