Provider Demographics
NPI:1659748440
Name:WILLIAMS, ANGIE
Entity Type:Individual
Prefix:
First Name:ANGIE
Middle Name:
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 1:316 50TH ST NE
Mailing Address - Street 2:APT 23
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-5353
Mailing Address - Country:US
Mailing Address - Phone:202-556-7987
Mailing Address - Fax:
Practice Address - Street 1:316 50TH ST NE
Practice Address - Street 2:APT 23
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-5353
Practice Address - Country:US
Practice Address - Phone:202-556-7987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-27
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11479374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide