Provider Demographics
NPI:1144659707
Name:WILLIAMS, LAVONNE
Entity type:Individual
Prefix:
First Name:LAVONNE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2639 WALNUT HILL LN
Mailing Address - Street 2:SUITE # 123
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229-5640
Mailing Address - Country:US
Mailing Address - Phone:214-613-9727
Mailing Address - Fax:214-613-1557
Practice Address - Street 1:2639 WALNUT HILL LN
Practice Address - Street 2:SUITE # 123
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75229-5640
Practice Address - Country:US
Practice Address - Phone:214-613-9727
Practice Address - Fax:214-613-1557
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care