Healthcare Provider Details

I. General information

NPI: 1679051288
Provider Name (Legal Business Name): CASSANDRA DENISE WILLIAMS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2018
Last Update Date: 08/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 DESIARD ST
MONROE LA
71201-7749
US

IV. Provider business mailing address

125 YORK DR
MONROE LA
71203-2443
US

V. Phone/Fax

Practice location:
  • Phone: 318-361-7355
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number123264
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: