Provider Demographics
NPI:1053964700
Name:WILLIAMS, LEANETTE GRACEIA
Entity type:Individual
Prefix:
First Name:LEANETTE
Middle Name:GRACEIA
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 1:15507 EMPRESS WAY
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-3217
Mailing Address - Country:US
Mailing Address - Phone:202-246-9910
Mailing Address - Fax:
Practice Address - Street 1:4638 H ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-4981
Practice Address - Country:US
Practice Address - Phone:202-243-0693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant