Provider Demographics
NPI:1427353309
Name:WILLIAMS, SHALA DAWN (RN-ABN)
Entity type:Individual
Prefix:
First Name:SHALA
Middle Name:DAWN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RN-ABN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6944 PLATTE AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68507-1463
Mailing Address - Country:US
Mailing Address - Phone:402-429-7981
Mailing Address - Fax:
Practice Address - Street 1:1000 S 13TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68508-3533
Practice Address - Country:US
Practice Address - Phone:402-477-3951
Practice Address - Fax:402-477-3922
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-24
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE70555163WP0809X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult