Healthcare Provider Details

I. General information

NPI: 1003733395
Provider Name (Legal Business Name): VANITRA WILLIAMS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 BLYTHE BLVD STE 500
CHARLOTTE NC
28203-5863
US

IV. Provider business mailing address

2009 ECHO FOREST DR APT 204
CHARLOTTE NC
28270-1354
US

V. Phone/Fax

Practice location:
  • Phone: 704-373-1813
  • Fax: 704-342-5871
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number321619
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: