Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1053987149 |
---|---|
Provider Name | Acquanetta Denise Williams |
First Address | Round Rock, TX 78681-1025 |
Second Address | Round Rock, TX 78664-6080 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2021 |
Last Update Date | 31/05/2021 |