Provider Demographics
NPI:1740859834
Name:WILLIAMS, JENNIFER S
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
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 1:4904 OSUNA PL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2531
Mailing Address - Country:US
Mailing Address - Phone:505-764-8231
Mailing Address - Fax:
Practice Address - Street 1:4904 OSUNA PL NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2531
Practice Address - Country:US
Practice Address - Phone:505-764-8231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator