Healthcare Provider Details

I. General information

NPI: 1982267241
Provider Name (Legal Business Name): RAQUEAL L. WILLIAMS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2019
Last Update Date: 04/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 LAROSE DR.
MOBILE AL
36609
US

IV. Provider business mailing address

406 LAROSE DR.
MOBILE AL
36609
US

V. Phone/Fax

Practice location:
  • Phone: 251-656-6873
  • Fax:
Mailing address:
  • Phone: 251-656-6873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number1-136068
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-136068
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: