Provider Demographics
NPI:1558171025
Name:WILLIAMS, CHYNA ANNETTE
Entity type:Individual
Prefix:MS
First Name:CHYNA
Middle Name:ANNETTE
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 1:1416 S PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21158-2720
Mailing Address - Country:US
Mailing Address - Phone:443-847-0408
Mailing Address - Fax:
Practice Address - Street 1:1718 N PULASKI ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-1140
Practice Address - Country:US
Practice Address - Phone:443-847-0408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAL-00502310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility