Provider Demographics
NPI:1841609088
Name:FORE-WILLIAMS, LATONYA S
Entity Type:Individual
Prefix:
First Name:LATONYA
Middle Name:S
Last Name:FORE-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 1:159 CROCKER PARK BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-8147
Mailing Address - Country:US
Mailing Address - Phone:216-815-1624
Mailing Address - Fax:216-930-5928
Practice Address - Street 1:159 CROCKER PARK BLVD STE 400
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-8147
Practice Address - Country:US
Practice Address - Phone:216-815-1624
Practice Address - Fax:216-930-5928
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.316441163W00000X
OHCOA 16548363L00000X
OHAPRNCNP16548363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0110937Medicaid
OHH385160Medicare PIN