Provider Demographics
NPI:1649563107
Name:WILLIAMS, ISLEAH QUIARRA
Entity Type:Individual
Prefix:
First Name:ISLEAH
Middle Name:QUIARRA
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 1:23300 PROVIDENCE DR
Mailing Address - Street 2:APT 215
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3652
Mailing Address - Country:US
Mailing Address - Phone:313-704-6189
Mailing Address - Fax:
Practice Address - Street 1:23300 PROVIDENCE DR
Practice Address - Street 2:APT 215
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3652
Practice Address - Country:US
Practice Address - Phone:313-704-6189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI230015057410710376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide