MEDICARE: YOLANDA P MITCHELL-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	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1710203757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YOLANDA P MITCHELL-WILLIAMS

Provider Business Mailing Address
First Line	:	8901 SUNGATE DR
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-3200
Country	:	US
Telephone Number	:	713-560-4823
Fax Number	:	281-485-7790

Provider Business Practice Location Address
First Line	:	8901 SUNGATE DR
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-3200
Country	:	US
Telephone Number	:	713-560-4823
Fax Number	:	281-485-7790

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

Provider Enumeration Date	:	04/15/2010
Last Update Date	:	04/15/2010

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