Provider Demographics
NPI:1528601093
Name:WILLIAMS, BRENDA VITA
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:VITA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11720 CLEAR RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-3151
Mailing Address - Country:US
Mailing Address - Phone:804-221-1596
Mailing Address - Fax:804-716-9254
Practice Address - Street 1:11720 CLEAR RIDGE DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-3151
Practice Address - Country:US
Practice Address - Phone:804-221-1596
Practice Address - Fax:804-716-9254
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle