1326383985 NPI number — MS. HAJI BERNICE WILLIAMS LPN

Table of content: MS. HAJI BERNICE WILLIAMS LPN (NPI 1326383985)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326383985 NPI number — MS. HAJI BERNICE WILLIAMS LPN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
HAJI
Provider Middle Name:
BERNICE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILLIAMS
Provider Other First Name:
HAJI
Provider Other Middle Name:
BERNICE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPN
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1326383985
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16345 VAN AKEN BLVD
Provider Second Line Business Mailing Address:
APT 1B
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44120-5399
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-640-5161
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16345 VAN AKEN BLVD
Provider Second Line Business Practice Location Address:
APT 1B
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44120-5399
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-640-5161
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/06/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 164W00000X , with the licence number:  PN 147376- M IV , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)