Provider Demographics
NPI:1801274584
Name:WILLIAMS, GLENDA
Entity type:Individual
Prefix:
First Name:GLENDA
Middle Name:
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 1:4547 N NEWSTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63115-2537
Mailing Address - Country:US
Mailing Address - Phone:314-503-1239
Mailing Address - Fax:314-381-6802
Practice Address - Street 1:4547 N NEWSTEAD AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63115-2537
Practice Address - Country:US
Practice Address - Phone:314-503-1239
Practice Address - Fax:314-381-6802
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty