MEDICARE: ZAQUEJ 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	164W00000X	Licensed Practical Nurse	PN308396	PA

General Provider Information

NPI Number	:	1912462854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZAQUEJ WILLIAMS

Provider Business Mailing Address
First Line	:	4842 N WARNOCK ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19141-3941
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4842 N WARNOCK ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19141-3941
Country	:	US
Telephone Number	:	267-388-1806
Fax Number	:

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

Provider Enumeration Date	:	02/05/2019
Last Update Date	:	02/05/2019

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