Provider Demographics
NPI:1134451214
Name:WILLIAMS, KERRIE COLLETTE (RN)
Entity type:Individual
Prefix:MS
First Name:KERRIE
Middle Name:COLLETTE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2617 BROOKVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-1440
Mailing Address - Country:US
Mailing Address - Phone:216-970-0902
Mailing Address - Fax:
Practice Address - Street 1:2617 BROOKVIEW BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-1440
Practice Address - Country:US
Practice Address - Phone:216-970-0902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-01
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH393707163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse