Provider Demographics
NPI:1033932454
Name:WILLIAMS, KEVA MARISA (CD-L, CD-PIC)
Entity type:Individual
Prefix:
First Name:KEVA
Middle Name:MARISA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CD-L, CD-PIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1253 W FRANCISCAN CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3250
Mailing Address - Country:US
Mailing Address - Phone:734-386-0124
Mailing Address - Fax:
Practice Address - Street 1:1253 W FRANCISCAN CT
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3250
Practice Address - Country:US
Practice Address - Phone:734-386-0124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIPICD010924374J00000X
MILD0101124374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula