Provider Demographics
NPI:1982863395
Name:WILLIAMS, PEARLINE (LPN)
Entity Type:Individual
Prefix:
First Name:PEARLINE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2518 N 39TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-3011
Mailing Address - Country:US
Mailing Address - Phone:414-447-0374
Mailing Address - Fax:414-447-0378
Practice Address - Street 1:2518 N 39TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-3011
Practice Address - Country:US
Practice Address - Phone:414-447-0374
Practice Address - Fax:414-447-0378
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI25178-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39887500Medicaid