MEDICARE: KATHLEEN ESTELLE WILLIAMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide

General Provider Information

NPI Number	:	1174081434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN ESTELLE WILLIAMS

Provider Business Mailing Address
First Line	:	7101 MINT PL APT 204
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22306-7153
Country	:	US
Telephone Number	:	571-345-4658
Fax Number	:

Provider Business Practice Location Address
First Line	:	12045TH STREET NORTH EAST
Second Line	:	613
City	:	WASHINGTON
State	:	DC
Zip	:	20019
Country	:	US
Telephone Number	:	202-817-4876
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2019
Last Update Date	:	03/06/2019

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