Provider Demographics
NPI:1366938714
Name:WILLIAMS, CHARLENE LAVETTE (RN)
Entity type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:LAVETTE
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 1:11307 NETTLEBROOK ST E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-1006
Mailing Address - Country:US
Mailing Address - Phone:904-738-9486
Mailing Address - Fax:
Practice Address - Street 1:11307 NETTLEBROOK ST E
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-1006
Practice Address - Country:US
Practice Address - Phone:904-738-9486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9176905163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management