Provider Demographics
NPI:1932732237
Name:WILLIAMS, ROBINA RENEE
Entity type:Individual
Prefix:
First Name:ROBINA
Middle Name:RENEE
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 1:17504 E CARRIAGEWAY DR STE B
Mailing Address - Street 2:
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-2089
Mailing Address - Country:US
Mailing Address - Phone:708-446-3221
Mailing Address - Fax:708-365-6253
Practice Address - Street 1:17504 E CARRIAGEWAY DR STE B
Practice Address - Street 2:
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2089
Practice Address - Country:US
Practice Address - Phone:708-446-3221
Practice Address - Fax:708-365-6253
Is Sole Proprietor?:No
Enumeration Date:2020-02-15
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3002151376J00000X
251S00000X, 253Z00000X, 282J00000X, 385H00000X
IL043.090690164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Yes376J00000XNursing Service Related ProvidersHomemaker
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
No282J00000XHospitalsReligious Nonmedical Health Care Institution
No385H00000XRespite Care FacilityRespite Care