Healthcare Provider Details

I. General information

NPI: 1710028030
Provider Name (Legal Business Name): MARILYN AUGUSTINE WILLIAMSON RN CS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HEMLOCK CT
STERLING VA
20164-2115
US

IV. Provider business mailing address

101 HEMLOCK CT
STERLING VA
20164-2115
US

V. Phone/Fax

Practice location:
  • Phone: 703-430-4600
  • Fax: 703-430-5500
Mailing address:
  • Phone: 703-430-4600
  • Fax: 703-430-5500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number0015000260
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: