Healthcare Provider Details

I. General information

NPI: 1801584156
Provider Name (Legal Business Name): STEPHANIE NICOLE WILLIAMS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2023
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CLIFFORD AVE
ALEXANDRIA VA
22305-2707
US

IV. Provider business mailing address

300 CLIFFORD AVE
ALEXANDRIA VA
22305-2707
US

V. Phone/Fax

Practice location:
  • Phone: 571-263-6967
  • Fax: 703-997-1394
Mailing address:
  • Phone: 571-263-6967
  • Fax: 703-997-1394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001258850
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License NumberNA
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: