Provider Demographics
NPI:1356942700
Name:WILLIAMS, MAXINE
Entity type:Individual
Prefix:
First Name:MAXINE
Middle Name:
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 1:2030 STAGECOACH TRL
Mailing Address - Street 2:
Mailing Address - City:HEARTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75126-8290
Mailing Address - Country:US
Mailing Address - Phone:469-412-9675
Mailing Address - Fax:
Practice Address - Street 1:2030 STAGECOACH TRL
Practice Address - Street 2:
Practice Address - City:HEARTLAND
Practice Address - State:TX
Practice Address - Zip Code:75126-8290
Practice Address - Country:US
Practice Address - Phone:469-412-9675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX580201163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse