Healthcare Provider Details

I. General information

NPI: 1326649310
Provider Name (Legal Business Name): MISS TASHANA STERLING WILLIAMSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2020
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 NYE ST
LIMA OH
45801-4641
US

IV. Provider business mailing address

501 NYE ST
LIMA OH
45801-4641
US

V. Phone/Fax

Practice location:
  • Phone: 419-860-8831
  • Fax: 419-860-8831
Mailing address:
  • Phone: 419-860-8831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number422222731119
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number402222731119
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: