Provider Demographics
NPI:1821532805
Name:DUPRIEST-WILLIAMS, LATASHA (CBRF/DIRECTOR)
Entity Type:Individual
Prefix:
First Name:LATASHA
Middle Name:
Last Name:DUPRIEST-WILLIAMS
Suffix:
Gender:F
Credentials:CBRF/DIRECTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4054 N 71ST ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-1026
Mailing Address - Country:US
Mailing Address - Phone:414-758-8382
Mailing Address - Fax:
Practice Address - Street 1:4054 N 71ST ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-1026
Practice Address - Country:US
Practice Address - Phone:414-758-8382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-11
Last Update Date:2016-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WID1625368564808172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver