MEDICARE: MS. JOHNETTA WILLIAMS R.N.

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	251J00000X	Nursing Care Agency

General Provider Information

NPI Number	:	1790984631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JOHNETTA WILLIAMS R.N.

Provider Business Mailing Address
First Line	:	PO BOX 533
Second Line	:
City	:	MARSHALL
State	:	TX
Zip	:	75671-0533
Country	:	US
Telephone Number	:	903-472-9274
Fax Number	:	903-938-4169

Provider Business Practice Location Address
First Line	:	2302 LOWER PORT CADDO RD
Second Line	:
City	:	MARSHALL
State	:	TX
Zip	:	75672-2232
Country	:	US
Telephone Number	:	903-472-9274
Fax Number	:	903-938-4169

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

Provider Enumeration Date	:	07/12/2007
Last Update Date	:	07/12/2007

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