Provider Demographics
NPI:1124303797
Name:WILLIAMS, SHINNEQUA (LPN)
Entity type:Individual
Prefix:MRS
First Name:SHINNEQUA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21326 GABLE MEADOWS LN
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-4169
Mailing Address - Country:US
Mailing Address - Phone:631-575-1081
Mailing Address - Fax:
Practice Address - Street 1:21326 GABLE MEADOWS LN
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-4169
Practice Address - Country:US
Practice Address - Phone:631-575-1081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-14
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307232164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse