Provider Demographics
NPI:1447904784
Name:WILLIAMS, LATANYA SHAREA (NONE)
Entity type:Individual
Prefix:
First Name:LATANYA
Middle Name:SHAREA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:NONE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33201 VINE ST APT 110B
Mailing Address - Street 2:
Mailing Address - City:WILLOWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44095-3402
Mailing Address - Country:US
Mailing Address - Phone:216-544-5882
Mailing Address - Fax:
Practice Address - Street 1:33201 VINE ST APT 110B
Practice Address - Street 2:
Practice Address - City:WILLOWICK
Practice Address - State:OH
Practice Address - Zip Code:44095-3402
Practice Address - Country:US
Practice Address - Phone:216-544-5882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide