Healthcare Provider Details

I. General information

NPI: 1376843862
Provider Name (Legal Business Name): EBUN VICTORIA WILLIAMS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2010
Last Update Date: 11/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6937 LAMONT DR
LANHAM MD
20706-4606
US

IV. Provider business mailing address

6937 LAMONT DR
LANHAM MD
20706-4606
US

V. Phone/Fax

Practice location:
  • Phone: 240-468-6077
  • Fax: 866-565-7126
Mailing address:
  • Phone: 240-468-6077
  • Fax: 877-565-7126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN968393
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: