Healthcare Provider Details

I. General information

NPI: 1760309579
Provider Name (Legal Business Name): AMANDA RAE WILLIAMS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 TARALYNN LN
CHESAPEAKE VA
23320-3398
US

IV. Provider business mailing address

1405 TARALYNN LN
CHESAPEAKE VA
23320-3398
US

V. Phone/Fax

Practice location:
  • Phone: 318-680-6063
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001246978
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: