Provider Demographics
NPI:1164197430
Name:WILLIAMS, SELENA COLLINS (RN, OWNER)
Entity Type:Individual
Prefix:
First Name:SELENA
Middle Name:COLLINS
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RN, OWNER
Other - Prefix:
Other - First Name:SELENA
Other - Middle Name:COLLINS
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, OWNER
Mailing Address - Street 1:41 S POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:ANGIER
Mailing Address - State:NC
Mailing Address - Zip Code:27501-6536
Mailing Address - Country:US
Mailing Address - Phone:910-703-1065
Mailing Address - Fax:
Practice Address - Street 1:800 N RALEIGH ST
Practice Address - Street 2:
Practice Address - City:ANGIER
Practice Address - State:NC
Practice Address - Zip Code:27501-8613
Practice Address - Country:US
Practice Address - Phone:910-275-9909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC255844163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health