Provider Demographics
NPI:1346046398
Name:WILLIAMS, SIDRA N (LPN)
Entity type:Individual
Prefix:
First Name:SIDRA
Middle Name:N
Last Name:WILLIAMS
Suffix:
Gender:
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15609 EVERGLADE LN APT 3
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-3270
Mailing Address - Country:US
Mailing Address - Phone:443-760-4045
Mailing Address - Fax:
Practice Address - Street 1:15609 EVERGLADE LN APT 3
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-3270
Practice Address - Country:US
Practice Address - Phone:443-760-4045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP46919164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse