Provider Demographics
NPI:1730218322
Name:WILLIAMS, LAKIESHA (STNA)
Entity type:Individual
Prefix:
First Name:LAKIESHA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:LAKIESHA
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:STNA
Mailing Address - Street 1:7700 AVONDALE AVE
Mailing Address - Street 2:4829 EAST 85TH GARFIELD HEIGHTS
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44125-1204
Mailing Address - Country:US
Mailing Address - Phone:216-253-1189
Mailing Address - Fax:
Practice Address - Street 1:7700 AVONDALE AVE
Practice Address - Street 2:4829 EAST 85TH GARFIELD HEIGHTS
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44125-1204
Practice Address - Country:US
Practice Address - Phone:216-253-1189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400392560804376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide