Healthcare Provider Details

I. General information

NPI: 1396333043
Provider Name (Legal Business Name): TRACEY LASHAWN WILLIAMS LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2021
Last Update Date: 11/24/2024
Certification Date: 11/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 CHARLES PLZ APT 1107
BALTIMORE MD
21201-4219
US

IV. Provider business mailing address

8 CHARLES PLZ APT 1107
BALTIMORE MD
21201-4219
US

V. Phone/Fax

Practice location:
  • Phone: 443-600-5691
  • Fax:
Mailing address:
  • Phone: 443-600-5691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR267970
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: