MEDICARE: LAVONNE WILLIAMS

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1144659707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAVONNE WILLIAMS

Provider Business Mailing Address
First Line	:	2639 WALNUT HILL LN
Second Line	:	SUITE # 123
City	:	DALLAS
State	:	TX
Zip	:	75229-5640
Country	:	US
Telephone Number	:	214-613-9727
Fax Number	:	214-613-1557

Provider Business Practice Location Address
First Line	:	2639 WALNUT HILL LN
Second Line	:	SUITE # 123
City	:	DALLAS
State	:	TX
Zip	:	75229-5640
Country	:	US
Telephone Number	:	214-613-9727
Fax Number	:	214-613-1557

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

Provider Enumeration Date	:	11/04/2013
Last Update Date	:	11/04/2013

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Directions to “ LAVONNE WILLIAMS ” Practice Location

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