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NPI Code Detail

MEDICARE: MRS. JEANNETTE MARIE WILLIAMS LVN

MEDICARE: MRS. JEANNETTE MARIE WILLIAMS LVN
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 NurseVN154487CA

General Provider Information

NPI Number : 1558438341
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JEANNETTE MARIE WILLIAMS LVN
Provider Business Mailing Address
First Line : 809 EMPEROR DR
Second Line :
City : SUISUN CITY
State : CA
Zip : 94585-2163
Country : US
Telephone Number : 707-435-1932
Fax Number :
Provider Business Practice Location Address
First Line : 1143 MISSOURI ST
Second Line :
City : FAIRFIELD
State : CA
Zip : 94533-6007
Country : US
Telephone Number : 707-435-9911
Fax Number : 707-435-0704
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2006
Last Update Date : 07/08/2007

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