MEDICARE: DR. BIANCA DESHAWN LEE WILLIAMS DNP

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	163W00000X	Registered Nurse	0001217042	VA
2	363L00000X	Nurse Practitioner	0024172559	VA
3	363L00000X	Nurse Practitioner	AC002923	MD

General Provider Information

NPI Number	:	1174903678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BIANCA DESHAWN LEE WILLIAMS DNP

Provider Business Mailing Address
First Line	:	11720 BELTSVILLE DR STE 500-A44
Second Line	:
City	:	BELTSVILLE
State	:	MD
Zip	:	20705-3166
Country	:	US
Telephone Number	:	202-813-0944
Fax Number	:

Provider Business Practice Location Address
First Line	:	11720 BELTSVILLE DR STE 500-A44
Second Line	:
City	:	BELTSVILLE
State	:	MD
Zip	:	20705-3166
Country	:	US
Telephone Number	:	202-813-0944
Fax Number	:

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

Provider Enumeration Date	:	06/01/2015
Last Update Date	:	04/01/2021

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