Provider Demographics
NPI:1457952004
Name:WILLIAMS, PATRICIA MAUREEN
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MAUREEN
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 1:175 W CAMPUS DR
Mailing Address - Street 2:110 LR HALL
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24061-1034
Mailing Address - Country:US
Mailing Address - Phone:540-231-8512
Mailing Address - Fax:
Practice Address - Street 1:175 W CAMPUS DR
Practice Address - Street 2:110 LR HALL
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24061-1034
Practice Address - Country:US
Practice Address - Phone:540-231-8512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0220001470174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist