Provider Demographics
NPI:1023612579
Name:WILLIAMS, DESHANA RACHELLE (CNA)
Entity type:Individual
Prefix:
First Name:DESHANA
Middle Name:RACHELLE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 S 74TH EAST PL APT 2
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-6336
Mailing Address - Country:US
Mailing Address - Phone:918-402-2832
Mailing Address - Fax:
Practice Address - Street 1:4701 S 74TH EAST PL APT 2
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-6336
Practice Address - Country:US
Practice Address - Phone:918-402-2832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK251J00000X
314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No251J00000XAgenciesNursing Care