Healthcare Provider Details

I. General information

NPI: 1508530809
Provider Name (Legal Business Name): CHARDAY SHANICE WILLIAMS CNA, CNA II
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 IRON MEADOW RUN APT 102
RALEIGH NC
27601-2446
US

IV. Provider business mailing address

610 IRON MEADOW RUN APT 102
RALEIGH NC
27601-2446
US

V. Phone/Fax

Practice location:
  • Phone: 919-288-4212
  • Fax:
Mailing address:
  • Phone: 919-288-4212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number440202
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number78355
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: