Provider Demographics
NPI:1184831950
Name:WILLIAMS, RENEE DUSOLD (FNP)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:DUSOLD
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:RENEE
Other - Middle Name:DUSOLD
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:410 CANTERBURY RD
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-4861
Mailing Address - Country:US
Mailing Address - Phone:919-934-5149
Mailing Address - Fax:919-934-5632
Practice Address - Street 1:410 CANTERBURY RD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4861
Practice Address - Country:US
Practice Address - Phone:919-934-5149
Practice Address - Fax:919-934-5632
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201361363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC201361OtherSTATE FNP LICENSE NUMBER
NC2805081Medicare PIN