Provider Demographics
NPI:1457150252
Name:WILLIAMS, LATASHA (LPN)
Entity type:Individual
Prefix:
First Name:LATASHA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 E RITTENHOUSE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-1247
Mailing Address - Country:US
Mailing Address - Phone:267-632-4392
Mailing Address - Fax:
Practice Address - Street 1:715 E RITTENHOUSE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-1247
Practice Address - Country:US
Practice Address - Phone:267-632-4392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN292069164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse