Provider Demographics
NPI:1386106789
Name:WILLIAMS, RENEE LANITA
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:LANITA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 16TH ST NE APT B35
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-5579
Mailing Address - Country:US
Mailing Address - Phone:301-281-5248
Mailing Address - Fax:
Practice Address - Street 1:1510 FORT DAVIS PL SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-6028
Practice Address - Country:US
Practice Address - Phone:202-583-6256
Practice Address - Fax:202-583-6256
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC1083283OtherPDW