Provider Demographics
NPI:1396073441
Name:WILLIAMS, PAULETTE YEVONNE
Entity type:Individual
Prefix:
First Name:PAULETTE
Middle Name:YEVONNE
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 1:1028 NE 2ND AVE
Mailing Address - Street 2:PO BOX 1028
Mailing Address - City:TRENTON
Mailing Address - State:FL
Mailing Address - Zip Code:32693-3302
Mailing Address - Country:US
Mailing Address - Phone:352-463-6687
Mailing Address - Fax:
Practice Address - Street 1:1028 NE 2ND AVE
Practice Address - Street 2:1028 NE 2ND AVE
Practice Address - City:TRENTON
Practice Address - State:FL
Practice Address - Zip Code:32693-3302
Practice Address - Country:US
Practice Address - Phone:352-463-6687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-01
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker