Provider Demographics
NPI:1700280385
Name:WILLIAMS, JENNIFER LU
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LU
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 1:575 E PLUMB LN
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-3540
Mailing Address - Country:US
Mailing Address - Phone:775-329-0623
Mailing Address - Fax:775-337-2971
Practice Address - Street 1:575 E PLUMB LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-3540
Practice Address - Country:US
Practice Address - Phone:775-329-0623
Practice Address - Fax:775-337-2971
Is Sole Proprietor?:No
Enumeration Date:2014-10-10
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1245447267Medicaid