Provider Demographics
NPI:1841855988
Name:SLADE, WILLIAM II
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:SLADE
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2022 HIGHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75041-2056
Mailing Address - Country:US
Mailing Address - Phone:218-214-0153
Mailing Address - Fax:
Practice Address - Street 1:2022 HIGHWOOD DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75041-2056
Practice Address - Country:US
Practice Address - Phone:218-214-0153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-03
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27294164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse