Provider Demographics
NPI:1922616523
Name:WILLIAMS, KEYONIA MICHELLE
Entity Type:Individual
Prefix:
First Name:KEYONIA
Middle Name:MICHELLE
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 1:6185 W MEADOW FARM LN
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-1892
Mailing Address - Country:US
Mailing Address - Phone:440-320-1541
Mailing Address - Fax:
Practice Address - Street 1:6185 W MEADOW FARM LN
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-1892
Practice Address - Country:US
Practice Address - Phone:440-320-1541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.346643163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse