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General NPI Number Information
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NPI Number | 1770364655
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Entity Type | Individual
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Provider Name | LATORIA MICHELLE WILLIAMS
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Gender | Female
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Dates
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Enumeration Date | 10/09/2023
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Last Update Date | 10/09/2023
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Provider Practice Location Address
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Address Line | 8181 N WAYNE RD APT C2035
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City | WESTLAND
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State | MI
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Zip | 48185-1123
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Country | US
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Telephone | 313-917-1451
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Fax |
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Provider Business Mailing Address
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Address Line | 9968 KINLOCH
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City | REDFORD
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State | MI
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Zip | 48239-2145
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Country | US
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Telephone | 313-944-3216
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 4703126023
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License Number State | MI
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