Healthcare Provider Details

I. General information

NPI: 1548669104
Provider Name (Legal Business Name): LATOSHIA DANIELLE WILLIAMS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2014
Last Update Date: 09/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 GARNER ROAD STE A
RALEIGH NC
27610-6669
US

IV. Provider business mailing address

1500 GARNER ROAD STE A
RALEIGH NC
27610-6669
US

V. Phone/Fax

Practice location:
  • Phone: 919-556-1008
  • Fax: 919-556-6099
Mailing address:
  • Phone: 919-556-1008
  • Fax: 919-556-6099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF0714653
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: