Provider Demographics
NPI:1396333043
Name:WILLIAMS, TRACEY LASHAWN (LPN)
Entity type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:LASHAWN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CHARLES PLZ APT 1107
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-4219
Mailing Address - Country:US
Mailing Address - Phone:443-600-5691
Mailing Address - Fax:
Practice Address - Street 1:8 CHARLES PLZ APT 1107
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-4219
Practice Address - Country:US
Practice Address - Phone:443-600-5691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-08
Last Update Date:2024-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR267970163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health