Healthcare Provider Details

I. General information

NPI: 1730218322
Provider Name (Legal Business Name): LAKIESHA WILLIAMS STNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAKIESHA WILLIAMS STNA

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 AVONDALE AVE 4829 EAST 85TH GARFIELD HEIGHTS
CLEVELAND OH
44125-1204
US

IV. Provider business mailing address

7700 AVONDALE AVE 4829 EAST 85TH GARFIELD HEIGHTS
CLEVELAND OH
44125-1204
US

V. Phone/Fax

Practice location:
  • Phone: 216-253-1189
  • Fax:
Mailing address:
  • Phone: 216-253-1189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number400392560804
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: