Provider Demographics
NPI:1497418438
Name:WILLIAMS, ROSHANA LAQUICE
Entity Type:Individual
Prefix:
First Name:ROSHANA
Middle Name:LAQUICE
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 1:527 MEADOW SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:GLENN HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:75154-7913
Mailing Address - Country:US
Mailing Address - Phone:940-782-5240
Mailing Address - Fax:
Practice Address - Street 1:527 MEADOW SPRINGS DR
Practice Address - Street 2:
Practice Address - City:GLENN HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:75154-7913
Practice Address - Country:US
Practice Address - Phone:940-782-5240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX182114164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse