Provider Demographics
NPI:1124579040
Name:WILLIAMS, GLENDA RIVERS (FNP-BC)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:RIVERS
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 GINGLIS WAY
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-7748
Mailing Address - Country:US
Mailing Address - Phone:843-813-6858
Mailing Address - Fax:
Practice Address - Street 1:4600 GOER DR
Practice Address - Street 2:SUITE 205
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-6500
Practice Address - Country:US
Practice Address - Phone:843-554-1029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCF19931174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist