Healthcare Provider Details

I. General information

NPI: 1760219158
Provider Name (Legal Business Name): STAR WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 WATERSIDE DR STE 2525
NORFOLK VA
23510-3316
US

IV. Provider business mailing address

8822 MONITOR WAY
NORFOLK VA
23503-4625
US

V. Phone/Fax

Practice location:
  • Phone: 804-956-1501
  • Fax: 757-330-1010
Mailing address:
  • Phone: 804-956-1501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberD5H9N8C6
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: