Provider Demographics
NPI:1740811710
Name:WILLIAMS, BRENDA MARIE
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name: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 1:315 POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23607-4940
Mailing Address - Country:US
Mailing Address - Phone:757-696-6629
Mailing Address - Fax:800-827-5809
Practice Address - Street 1:315 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23607-4940
Practice Address - Country:US
Practice Address - Phone:757-696-6629
Practice Address - Fax:800-827-5809
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)