Provider Demographics
NPI:1275078578
Name:WILLIAMS, NATALIE ANNE (PA)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:ANNE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12109 ASH FLEETWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAVALE
Mailing Address - State:MD
Mailing Address - Zip Code:21502-6023
Mailing Address - Country:US
Mailing Address - Phone:240-727-0440
Mailing Address - Fax:
Practice Address - Street 1:45 HUNT CLUB DR
Practice Address - Street 2:
Practice Address - City:RIDGELEY
Practice Address - State:WV
Practice Address - Zip Code:26753-7567
Practice Address - Country:US
Practice Address - Phone:304-726-4501
Practice Address - Fax:304-726-4051
Is Sole Proprietor?:No
Enumeration Date:2016-12-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDC06402363A00000X
WV2151363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant