MEDICARE: JAWANZA 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	LPN14611	NV
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1144731704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAWANZA WILLIAMS LPN

Provider Business Mailing Address
First Line	:	3316 MASTERCRAFT AVE
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89031-7239
Country	:	US
Telephone Number	:	702-929-1438
Fax Number	:

Provider Business Practice Location Address
First Line	:	3316 MASTERCRAFT AVE
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89031-7239
Country	:	US
Telephone Number	:	702-929-1438
Fax Number	:

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

Provider Enumeration Date	:	10/23/2017
Last Update Date	:	10/23/2017

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