Healthcare Provider Details

I. General information

NPI: 1841609088
Provider Name (Legal Business Name): LATONYA S FORE-WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2014
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 CROCKER PARK BLVD STE 400
WESTLAKE OH
44145-8147
US

IV. Provider business mailing address

159 CROCKER PARK BLVD STE 400
WESTLAKE OH
44145-8147
US

V. Phone/Fax

Practice location:
  • Phone: 216-815-1624
  • Fax: 216-930-5928
Mailing address:
  • Phone: 216-815-1624
  • Fax: 216-930-5928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCOA 16548
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRNCNP16548
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.316441
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: