Provider Demographics
NPI:1699370254
Name:WILLIAMS, DANIELLE
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
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 1:225 NAOMI AVE
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-6230
Mailing Address - Country:US
Mailing Address - Phone:314-504-1538
Mailing Address - Fax:833-983-5015
Practice Address - Street 1:225 NAOMI AVE
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-6230
Practice Address - Country:US
Practice Address - Phone:314-504-1538
Practice Address - Fax:833-983-5015
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health