Provider Demographics
NPI:1780434449
Name:WILLIAMS, TYESHA LYNN
Entity type:Individual
Prefix:
First Name:TYESHA
Middle Name:LYNN
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 1:1647 SOUTHERN BLVD NW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44485-2051
Mailing Address - Country:US
Mailing Address - Phone:330-787-6543
Mailing Address - Fax:
Practice Address - Street 1:1647 SOUTHERN BLVD NW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44485-2051
Practice Address - Country:US
Practice Address - Phone:330-787-6543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker