Healthcare Provider Details

I. General information

NPI: 1043650492
Provider Name (Legal Business Name): LAJUNE NICOLE WILLIAMS CSFA, LSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2013
Last Update Date: 05/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 JAMES ADKINS DR
KYLE TX
78640-4230
US

IV. Provider business mailing address

PO BOX 2576
KYLE TX
78640-1815
US

V. Phone/Fax

Practice location:
  • Phone: 512-938-2664
  • Fax:
Mailing address:
  • Phone: 512-938-2664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number142056
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: