Provider Demographics
NPI:1750852554
Name:WILLIAMS, NICHOLE LASHA (FNP)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:LASHA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9612 STUART LN
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-3376
Mailing Address - Country:US
Mailing Address - Phone:843-260-2748
Mailing Address - Fax:
Practice Address - Street 1:12070 OLD LINE CTR STE 303
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3535
Practice Address - Country:US
Practice Address - Phone:301-645-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-06
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22529363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily