Provider Demographics
NPI:1326383985
Name:WILLIAMS, HAJI BERNICE (LPN)
Entity Type:Individual
Prefix:MS
First Name:HAJI
Middle Name:BERNICE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:HAJI
Other - Middle Name:BERNICE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:16345 VAN AKEN BLVD
Mailing Address - Street 2:APT 1B
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-5399
Mailing Address - Country:US
Mailing Address - Phone:216-640-5161
Mailing Address - Fax:
Practice Address - Street 1:16345 VAN AKEN BLVD
Practice Address - Street 2:APT 1B
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-5399
Practice Address - Country:US
Practice Address - Phone:216-640-5161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 147376- M IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse