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General NPI Number Information
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NPI Number | 1255657748
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Entity Type | Individual
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Provider Name | CECILLIA WILLIAMS-HUBBARD LPN
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Gender | Female
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Dates
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Enumeration Date | 04/09/2010
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Last Update Date | 10/29/2015
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Provider Practice Location Address
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Address Line | 1506 MARY KAY BLVD
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City | BENTON
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State | AR
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Zip | 72015
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Country | US
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Telephone | 501-303-1665
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Fax |
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Provider Business Mailing Address
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Address Line | 21 WEDGESIDE DR
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City | LITTLE ROCK
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State | AR
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Zip | 72210-4137
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Country | US
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Telephone | 501-455-1389
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | L42135
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License Number State | AR
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