Provider Demographics
NPI:1366853533
Name:WILLIAMS, KEENA
Entity Type:Individual
Prefix:
First Name:KEENA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1038 NELA VIEW RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44112-2357
Mailing Address - Country:US
Mailing Address - Phone:216-785-4865
Mailing Address - Fax:216-471-8088
Practice Address - Street 1:1038 NELA VIEW RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44112-2357
Practice Address - Country:US
Practice Address - Phone:216-785-4865
Practice Address - Fax:216-471-8088
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-09
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0071492Medicaid