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NPI Code Detail

MEDICARE: LISA WILLIAMS

MEDICARE: LISA 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
1164X00000XLicensed Vocational NursePN 5150203FL

General Provider Information

NPI Number : 1508196411
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA WILLIAMS
Provider Business Mailing Address
First Line : 253 E MARIGOLD AVE
Second Line :
City : DEFUNIAK SPRINGS
State : FL
Zip : 32433-6518
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 114 3RD ST SE
Second Line :
City : FORT WALTON BEACH
State : FL
Zip : 32548-5401
Country : US
Telephone Number : 850-243-6134
Fax Number : 850-243-9759
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2009
Last Update Date : 12/29/2009

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Directions to “ LISA WILLIAMS ” Practice Location

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