MEDICARE: GLORIA MAE WILLIAMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1326300641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLORIA MAE WILLIAMS

Provider Business Mailing Address
First Line	:	3729 SENECA HIGHLAND ST.,
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-0493
Country	:	US
Telephone Number	:	702-631-8044
Fax Number	:

Provider Business Practice Location Address
First Line	:	3729 SENECA HIGHLAND ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-0493
Country	:	US
Telephone Number	:	702-631-8044
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2012
Last Update Date	:	06/12/2012

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