Provider Demographics
NPI:1922582790
Name:WILLIAMS, PAMELA ANNE MARIE
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANNE MARIE
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 1:11902 WINTERTHUR LN APT 106
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-1919
Mailing Address - Country:US
Mailing Address - Phone:347-636-4873
Mailing Address - Fax:
Practice Address - Street 1:11731 SUMMERCHASE CIR APT D
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20194-1141
Practice Address - Country:US
Practice Address - Phone:347-636-4873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1401193713OtherDEPARTMENT OF HEALTH PROFESSIONS
VA1401193713OtherCOMMONWEALTH OF VIRGINIA