Provider Demographics
NPI:1538937982
Name:WILLIAMS, THERESA RENEE
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:RENEE
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 1:302 E SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:CARMICHAELS
Mailing Address - State:PA
Mailing Address - Zip Code:15320-1246
Mailing Address - Country:US
Mailing Address - Phone:724-208-9705
Mailing Address - Fax:
Practice Address - Street 1:302 E SOUTH ST
Practice Address - Street 2:
Practice Address - City:CARMICHAELS
Practice Address - State:PA
Practice Address - Zip Code:15320-1246
Practice Address - Country:US
Practice Address - Phone:724-208-9705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP49558900164W00000X
WALP61401019164W00000X
RILPN13299164W00000X
PAPN317593164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse