Healthcare Provider Details

I. General information

NPI: 1700438553
Provider Name (Legal Business Name): AUTUMN LEIGH WILLIAMS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AUTUMN LEIGH CLEVENGER

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 GALLOWS RD
FALLS CHURCH VA
22042-3300
US

IV. Provider business mailing address

210 HUPPS HILL CT
STRASBURG VA
22657-2388
US

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone: 540-664-6571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number0024177840
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: