Healthcare Provider Details

I. General information

NPI: 1205209855
Provider Name (Legal Business Name): ELLEN VASHTI WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2015
Last Update Date: 11/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 L ST NW SUITE 900
WASHINGTON DC
20036-4201
US

IV. Provider business mailing address

4256 SUITLAND RD APT 101
SUITLAND MD
20746-2059
US

V. Phone/Fax

Practice location:
  • Phone: 202-829-1111
  • Fax:
Mailing address:
  • Phone: 202-830-4674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN966623
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: