Provider Demographics
NPI:1184340143
Name:WILLIAMS, PAULETTE (DBA)
Entity type:Individual
Prefix:DR
First Name:PAULETTE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1552 S ROUTE 59 STE 1244
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-5941
Mailing Address - Country:US
Mailing Address - Phone:847-649-4377
Mailing Address - Fax:
Practice Address - Street 1:1552 S ROUTE 59 STE 1244
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-5941
Practice Address - Country:US
Practice Address - Phone:847-649-4377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator
No172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA012915662Medicaid