Provider Demographics
NPI:1811781982
Name:WILLIAMS, DESTINEY MONIA
Entity type:Individual
Prefix:
First Name:DESTINEY
Middle Name:MONIA
Last Name:WILLIAMS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 GENOA ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61102-2613
Mailing Address - Country:US
Mailing Address - Phone:815-382-2534
Mailing Address - Fax:
Practice Address - Street 1:2784 KENSINGTON PL
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61109-1816
Practice Address - Country:US
Practice Address - Phone:815-382-2534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-05
Last Update Date:2025-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1098479164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse