Provider Demographics
NPI:1235124405
Name:WILLIAMSON, EDEN C (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:EDEN
Middle Name:C
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:EDEN
Other - Middle Name:C
Other - Last Name:JINGCO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:8115 CRADDOCK RD
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3053
Mailing Address - Country:US
Mailing Address - Phone:301-552-8708
Mailing Address - Fax:
Practice Address - Street 1:4555 OVERLOOK AVE SW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20375-0001
Practice Address - Country:US
Practice Address - Phone:202-404-8430
Practice Address - Fax:202-404-8154
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN620086163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse