Provider Demographics
NPI:1699009233
Name:WILLIAMS, LA'SHAWNA THERESE (LICENSED LPN)
Entity Type:Individual
Prefix:MISS
First Name:LA'SHAWNA
Middle Name:THERESE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LICENSED LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4332 HERITAGE DR APT 4A7
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-2038
Mailing Address - Country:US
Mailing Address - Phone:315-470-1262
Mailing Address - Fax:
Practice Address - Street 1:4332 HERITAGE DR APT 4A7
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-2038
Practice Address - Country:US
Practice Address - Phone:315-470-1262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY297669-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse