Healthcare Provider Details

I. General information

NPI: 1619787827
Provider Name (Legal Business Name): MARDREYANNA WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2025
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N. RAINBOW BLVD., SUITE 300
LAS VEGAS NV
89107
US

IV. Provider business mailing address

500 N. RAINBOW BLVD., SUITE 300
LAS VEGAS NV
89107
US

V. Phone/Fax

Practice location:
  • Phone: 702-448-8145
  • Fax:
Mailing address:
  • Phone: 702-448-8145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: