Healthcare Provider Details

I. General information

NPI: 1164197430
Provider Name (Legal Business Name): SELENA COLLINS WILLIAMS RN, OWNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SELENA COLLINS WILLIAMS RN, OWNER

II. Dates (important events)

Enumeration Date: 08/10/2021
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N RALEIGH ST
ANGIER NC
27501-8613
US

IV. Provider business mailing address

41 S POPLAR ST
ANGIER NC
27501-6536
US

V. Phone/Fax

Practice location:
  • Phone: 910-275-9909
  • Fax:
Mailing address:
  • Phone: 910-703-1065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number255844
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: