Provider Demographics
NPI:1801133145
Name:WILLIAMS, LAUREN BLAKE (RN)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:BLAKE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 RED RAIDER DR
Mailing Address - Street 2:
Mailing Address - City:BAMBERG
Mailing Address - State:SC
Mailing Address - Zip Code:29003-1746
Mailing Address - Country:US
Mailing Address - Phone:803-245-2000
Mailing Address - Fax:803-245-6502
Practice Address - Street 1:267 RED RAIDER DR
Practice Address - Street 2:
Practice Address - City:BAMBERG
Practice Address - State:SC
Practice Address - Zip Code:29003-1746
Practice Address - Country:US
Practice Address - Phone:803-245-2000
Practice Address - Fax:803-245-6502
Is Sole Proprietor?:No
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC101493163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse