Healthcare Provider Details

I. General information

NPI: 1104244664
Provider Name (Legal Business Name): NATHAN WILLIAMS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 12/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8014 MIDLOTHIAN TURNPIKE SUITE 202
RICHMOND VA
23235
US

IV. Provider business mailing address

PO BOX 75301
NORTH CHESTERFIELD VA
23236
US

V. Phone/Fax

Practice location:
  • Phone: 804-525-4068
  • Fax: 804-525-4189
Mailing address:
  • Phone: 804-943-7358
  • Fax: 804-525-4189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number0001235688
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number0001235688
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number0001235688
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number0001235688
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: