Provider Demographics
NPI:1699562769
Name:WILLIAMS, TYLIEA (LVN)
Entity type:Individual
Prefix:
First Name:TYLIEA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 MALLARD CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-2547
Mailing Address - Country:US
Mailing Address - Phone:213-841-5566
Mailing Address - Fax:
Practice Address - Street 1:530 UNION AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-6367
Practice Address - Country:US
Practice Address - Phone:707-784-7150
Practice Address - Fax:707-421-6674
Is Sole Proprietor?:No
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA276329164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse