MEDICARE: MS. VANESSA WILLIAMS CRNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AC007274	MD

General Provider Information

NPI Number	:	1609688241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VANESSA WILLIAMS CRNP

Provider Business Mailing Address
First Line	:	2670 CRAIN HWY STE 510
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20601-2819
Country	:	US
Telephone Number	:	301-778-1335
Fax Number	:

Provider Business Practice Location Address
First Line	:	2670 CRAIN HWY STE 510
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20601-2819
Country	:	US
Telephone Number	:	301-778-1335
Fax Number	:

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

Provider Enumeration Date	:	01/21/2025
Last Update Date	:	03/18/2026

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