Provider Demographics
NPI:1497412480
Name:WILLAMS, SHANON LATRICE (NURSING ASSISTANT)
Entity Type:Individual
Prefix:
First Name:SHANON
Middle Name:LATRICE
Last Name:WILLAMS
Suffix:
Gender:F
Credentials:NURSING ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1928 S FERN ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67213-3544
Mailing Address - Country:US
Mailing Address - Phone:316-749-9770
Mailing Address - Fax:
Practice Address - Street 1:1928 S FERN ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67213-3544
Practice Address - Country:US
Practice Address - Phone:316-749-9770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-24
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide