Provider Demographics
NPI:1356726285
Name:WILLIAMS, LURLENE D
Entity type:Individual
Prefix:
First Name:LURLENE
Middle Name:D
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 1:2666 VISTA RISE APT B
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32304-1290
Mailing Address - Country:US
Mailing Address - Phone:850-524-0805
Mailing Address - Fax:
Practice Address - Street 1:2666 VISTA RISE APT B
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32304-1290
Practice Address - Country:US
Practice Address - Phone:850-524-0805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLW450524766740172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL595730Medicaid