Provider Demographics
NPI:1750634770
Name:MILLER-WILLIAMS, CRYSTAL DENISE (NP)
Entity Type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:DENISE
Last Name:MILLER-WILLIAMS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10514 WAKEMAN DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-8040
Mailing Address - Country:US
Mailing Address - Phone:540-993-4473
Mailing Address - Fax:
Practice Address - Street 1:10514 WAKEMAN DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-8040
Practice Address - Country:US
Practice Address - Phone:540-993-4473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-16
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN261444363LF0000X
VA0024170401363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVVC101AMedicare PIN