Provider Demographics
NPI:1497574131
Name:WILLIAMS, TINA
Entity type:Individual
Prefix:
First Name:TINA
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 1:3265 W LAKE MEAD BLVD UNIT 1348
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-4911
Mailing Address - Country:US
Mailing Address - Phone:775-292-0796
Mailing Address - Fax:
Practice Address - Street 1:3265 W LAKE MEAD BLVD UNIT 1109
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-4906
Practice Address - Country:US
Practice Address - Phone:702-525-5744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X
NVN-48665173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant