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1972301091 NPI number — SERENA M WILLIAMS FNP-C

NPI Number: 1972301091
Health Care Provider/Practitioner: SERENA M WILLIAMS FNP-C

Information about “1972301091” NPI (SERENA M WILLIAMS FNP-C) exists in 1972301091 in HTML format HTML  |  1972301091 in plain Text format TXT  |  1972301091 in PDF (Portable Document Format) PDF  |  1972301091 in an XML format XML  formats.

NPI Number : 1972301091 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1972301091",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WILLIAMS",
    "FirstName": "SERENA",
    "MiddleName": "M",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "FNP-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3920 ORDINARY LOOP",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HAYES",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "23072-2955",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "804-832-9306",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3000 COLISEUM DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HAMPTON",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "23666-5963",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "757-736-1000",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/05/2025",
    "LastUpdateDate": "03/06/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363L00000X",
        "TaxonomyName": "Nurse Practitioner",
        "LicenseNumber": "0024192820",
        "LicenseNumberStateCode": "VA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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