Healthcare Provider Details

I. General information

NPI: 1669958187
Provider Name (Legal Business Name): RENEE WILLIAMS-DELOACH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5412 BOULDER HWY
LAS VEGAS NV
89122-6039
US

IV. Provider business mailing address

5412 BOULDER HWY
LAS VEGAS NV
89122-6039
US

V. Phone/Fax

Practice location:
  • Phone: 708-674-6403
  • Fax: 702-854-9971
Mailing address:
  • Phone: 708-674-6403
  • Fax: 702-864-9971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberTRN357021
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: