Basic Information
Provider Information
NPI: 1477894145
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WILLIAMS
FirstName: SHAMEKA
MiddleName: LASHAY
NamePrefix:  
NameSuffix:  
Credential: CNM
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4700 LAS VEGAS BLVD N BLDG 1300
Address2:  
City: NELLIS AFB
State: NV
PostalCode: 891916600
CountryCode: US
TelephoneNumber: 7026532300
FaxNumber: 7026532109
Practice Location
Address1: 4700 LAS VEGAS BLVD N BLDG 1300
Address2:  
City: NELLIS AFB
State: NV
PostalCode: 891916600
CountryCode: US
TelephoneNumber: 7026532300
FaxNumber: 7026532109
Other Information
ProviderEnumerationDate: 03/06/2013
LastUpdateDate: 05/06/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367A00000XRN188135GAY Physician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife 

No ID Information.


Home