Provider Demographics
NPI:1710028030
Name:WILLIAMSON, MARILYN AUGUSTINE (RN CS)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:AUGUSTINE
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:RN CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 HEMLOCK CT
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20164-2115
Mailing Address - Country:US
Mailing Address - Phone:703-430-4600
Mailing Address - Fax:703-430-5500
Practice Address - Street 1:101 HEMLOCK CT
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20164-2115
Practice Address - Country:US
Practice Address - Phone:703-430-4600
Practice Address - Fax:703-430-5500
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0015000260364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1206446OtherAETNA
NYA235647OtherVALUE OPTIONS
KY0007956784OtherAETNA INSURANCE
NYA477858OtherVALUE OPTIONS INS. CO.
MI7102000VA23286OtherBCBS OF MICHIGAN
VA0000000027810OtherANTHEM BCBS
TX1206446OtherAETNA