Provider Demographics
NPI:1750199741
Name:WILLIAMS, STEPHANIE R
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:R
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 1:21102 SUN HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-6579
Mailing Address - Country:US
Mailing Address - Phone:832-541-5745
Mailing Address - Fax:
Practice Address - Street 1:2506 TRUXILLO ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-4370
Practice Address - Country:US
Practice Address - Phone:832-541-5745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-21
Last Update Date:2024-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility