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Organization
FULL POTENTIAL
Active
Organization
FULL POTENTIAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TANISHIA MARIE WILLIAMS LPN (NURSE)
(501) 442-3268
Entity
Organization
Contact information
Practice address
8109 INTERSTATE 30, LITTLE ROCK, AR 72209
(501) 442-3268
Mailing address
P.O. BOX 244, MABELVALE, AR 72103
(501) 442-3268
Taxonomy
Speciality
Code
Description
License number
State
3140N1450X
Pediatric Skilled Nursing Facility
Primary
L46656
AR
Other
Enumeration date
12/08/2011
Last updated
12/08/2011
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