Healthcare Provider Details

I. General information

NPI: 1730158874
Provider Name (Legal Business Name): N WYNTA WILLIAMS DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: N WYNTA WILLIAMS DPM

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 05/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4224 HOLLAND RD SUITE #106
VIRGINIA BEACH VA
23452-1900
US

IV. Provider business mailing address

4224 HOLLAND RD SUITE #106
VIRGINIA BEACH VA
23452-1900
US

V. Phone/Fax

Practice location:
  • Phone: 757-498-0202
  • Fax: 757-498-7936
Mailing address:
  • Phone: 757-498-0202
  • Fax: 757-498-7936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number0103000797
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: