Provider Demographics
NPI:1831575950
Name:WILLIAMS, MARISKA (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:MARISKA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8502 TOPAZ CT
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-3342
Mailing Address - Country:US
Mailing Address - Phone:410-724-2621
Mailing Address - Fax:410-505-6657
Practice Address - Street 1:8502 TOPAZ CT
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-3342
Practice Address - Country:US
Practice Address - Phone:410-724-2621
Practice Address - Fax:410-505-6657
Is Sole Proprietor?:No
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR196774163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse