Provider Demographics
NPI:1972335826
Name:WILLIAMS, ROSITA EVAT (CHW)
Entity type:Individual
Prefix:MS
First Name:ROSITA
Middle Name:EVAT
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72300 ERIKA WAY APT 204
Mailing Address - Street 2:
Mailing Address - City:SOUTH HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49090-7121
Mailing Address - Country:US
Mailing Address - Phone:269-998-2413
Mailing Address - Fax:
Practice Address - Street 1:72300 ERIKA WAY APT 204
Practice Address - Street 2:
Practice Address - City:SOUTH HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49090-7121
Practice Address - Country:US
Practice Address - Phone:269-998-2413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI109728433172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker