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General NPI Number Information
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NPI Number | 1609474626
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Entity Type | Individual
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Provider Name | ANDTRIA WILLIAMS-WILLIS LVN
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Gender | Female
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Dates
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Enumeration Date | 10/12/2020
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Last Update Date | 10/12/2020
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Provider Practice Location Address
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Address Line | 17350 STATE HIGHWAY 249 STE 220
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City | HOUSTON
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State | TX
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Zip | 77064-1132
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Country | US
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Telephone | 254-598-1305
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Fax |
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Provider Business Mailing Address
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Address Line | 3101 W ADAMS AVE APT 212
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City | TEMPLE
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State | TX
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Zip | 76504-2843
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Country | US
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Telephone | 254-598-1305
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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 | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | 351982
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License Number State | TX
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