MEDICARE: SHIRLESTINE WILLIAMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide	88-3768507	NC

General Provider Information

NPI Number	:	1295457232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIRLESTINE WILLIAMS

Provider Business Mailing Address
First Line	:	PO BOX 143
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27802-0143
Country	:	US
Telephone Number	:	252-813-1819
Fax Number	:

Provider Business Practice Location Address
First Line	:	1621 FOUNTAIN ST
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27801-3526
Country	:	US
Telephone Number	:	252-813-1819
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2022
Last Update Date	:	09/15/2022

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Directions to “ SHIRLESTINE WILLIAMS ” Practice Location

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