Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LP2300X | Nurse Practitioner - Primary Care | 901863 | MS |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 95008190 | CA |
NPI | 1063912046 |
---|---|
Provider Name | Laquania Williams |
First Address | Vardaman, MS 38878-9770 |
Second Address | Vardaman, MS 38878-9770 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2018 |
Last Update Date | 16/02/2018 |