Provider Demographics
NPI:1003235789
Name:WILLIAMS, JENNIFER DENISE (RN BSN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DENISE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CHARLESTON CENTER DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29401-1162
Mailing Address - Country:US
Mailing Address - Phone:843-579-4549
Mailing Address - Fax:
Practice Address - Street 1:3 CHARLESTON CENTER DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-1162
Practice Address - Country:US
Practice Address - Phone:843-579-4549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC104463163WC1500X, 163WM0102X, 163WX0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient