MEDICARE: ANGELA D WILLIAMS LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	LPN17731	NV

General Provider Information

NPI Number	:	1093578833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA D WILLIAMS LPN

Provider Business Mailing Address
First Line	:	9416 WAKASHAN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-0501
Country	:	US
Telephone Number	:	702-717-2372
Fax Number	:

Provider Business Practice Location Address
First Line	:	3770 HOWARD HUGHES PKWY STE 295
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-0998
Country	:	US
Telephone Number	:	702-369-9828
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2024
Last Update Date	:	02/05/2024

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