Provider Demographics
NPI:1285330506
Name:WILLIAMS, TATYANA ROSEMAE
Entity type:Individual
Prefix:
First Name:TATYANA
Middle Name:ROSEMAE
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 1:4955 S DURANGO DR STE 120
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-1054
Mailing Address - Country:US
Mailing Address - Phone:702-871-2273
Mailing Address - Fax:
Practice Address - Street 1:4955 S DURANGO DR STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-1054
Practice Address - Country:US
Practice Address - Phone:702-871-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No385H00000XRespite Care FacilityRespite Care
No376J00000XNursing Service Related ProvidersHomemaker