Provider Demographics
NPI:1679850952
Name:WILLIAMS, CRYSTAL-LEE SIMONE (LPN)
Entity type:Individual
Prefix:
First Name:CRYSTAL-LEE
Middle Name:SIMONE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11120 169TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11433-3920
Mailing Address - Country:US
Mailing Address - Phone:917-495-6427
Mailing Address - Fax:
Practice Address - Street 1:11120 169TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11433-3920
Practice Address - Country:US
Practice Address - Phone:917-495-6427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307447164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse