Provider Demographics
NPI:1316275571
Name:WILLIAMS, SHARISE (RN)
Entity type:Individual
Prefix:MRS
First Name:SHARISE
Middle Name:
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 1:50 BLACK JACK CT
Mailing Address - Street 2:
Mailing Address - City:BLACK JACK
Mailing Address - State:MO
Mailing Address - Zip Code:63033-2326
Mailing Address - Country:US
Mailing Address - Phone:314-653-0500
Mailing Address - Fax:314-653-0545
Practice Address - Street 1:50 BLACK JACK CT
Practice Address - Street 2:
Practice Address - City:BLACK JACK
Practice Address - State:MO
Practice Address - Zip Code:63033-2326
Practice Address - Country:US
Practice Address - Phone:314-972-1624
Practice Address - Fax:314-653-0545
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-30
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care