Provider Demographics
NPI:1801584156
Name:WILLIAMS, STEPHANIE NICOLE (RN)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:NICOLE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CLIFFORD AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22305-2707
Mailing Address - Country:US
Mailing Address - Phone:571-263-6967
Mailing Address - Fax:703-997-1394
Practice Address - Street 1:300 CLIFFORD AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22305-2707
Practice Address - Country:US
Practice Address - Phone:571-263-6967
Practice Address - Fax:703-997-1394
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-25
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001258850163W00000X
NA174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No163W00000XNursing Service ProvidersRegistered Nurse