Healthcare Provider Details

I. General information

NPI: 1023795341
Provider Name (Legal Business Name): RUTHIE L WILLIAMS LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2023
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6505 ROCKSIDE RD STE 175A
INDEPENDENCE OH
44131-2342
US

IV. Provider business mailing address

12404 MILES AVE
CLEVELAND OH
44105-5535
US

V. Phone/Fax

Practice location:
  • Phone: 440-990-0513
  • Fax:
Mailing address:
  • Phone: 440-645-1122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number188532
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number188532
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: