Provider Demographics
NPI:1477737906
Name:FORNEY-WILLIAMS, LAVERNE E (RN)
Entity Type:Individual
Prefix:MS
First Name:LAVERNE
Middle Name:E
Last Name:FORNEY-WILLIAMS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-4099
Mailing Address - Country:US
Mailing Address - Phone:510-595-6316
Mailing Address - Fax:
Practice Address - Street 1:1000 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607
Practice Address - Country:US
Practice Address - Phone:510-595-6316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA547050163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health