Provider Demographics
NPI:1831317189
Name:WILLIAMS, TAWANDA (RN)
Entity type:Individual
Prefix:
First Name:TAWANDA
Middle Name:
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 1:2200 HUNT ST STE 435
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-5602
Mailing Address - Country:US
Mailing Address - Phone:313-980-2500
Mailing Address - Fax:313-731-1820
Practice Address - Street 1:2200 HUNT ST STE 435
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-5602
Practice Address - Country:US
Practice Address - Phone:313-980-2500
Practice Address - Fax:313-980-2500
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704293812163W00000X
374U00000X
MI374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No163W00000XNursing Service ProvidersRegistered Nurse
No374U00000XNursing Service Related ProvidersHome Health Aide