Provider Demographics
NPI:1376663948
Name:WILLIAMS, DAVID WAYNE (LVN PT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:WAYNE
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LVN PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 PARSON BROWN
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-1107
Mailing Address - Country:US
Mailing Address - Phone:562-833-6147
Mailing Address - Fax:
Practice Address - Street 1:97 PARSON BROWN
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-1107
Practice Address - Country:US
Practice Address - Phone:562-833-6147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2016-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 148733164X00000X
CAPT31010167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No167G00000XNursing Service ProvidersLicensed Psychiatric Technician