MEDICARE: TINA 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	3747P1801X	Personal Care Attendant
2	173C00000X	Reflexologist	N-48665	NV

General Provider Information

NPI Number	:	1497574131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA WILLIAMS

Provider Business Mailing Address
First Line	:	3265 W LAKE MEAD BLVD UNIT 1348
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-4911
Country	:	US
Telephone Number	:	775-292-0796
Fax Number	:

Provider Business Practice Location Address
First Line	:	3265 W LAKE MEAD BLVD UNIT 1109
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-4906
Country	:	US
Telephone Number	:	702-525-5744
Fax Number	:

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

Provider Enumeration Date	:	10/09/2024
Last Update Date	:	10/09/2024

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Directions to “ TINA WILLIAMS ” Practice Location

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