MEDICARE: EDEN C WILLIAMSON REGISTERED NURSE

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	RN620086	DC

General Provider Information

NPI Number	:	1235124405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDEN C WILLIAMSON REGISTERED NURSE

Provider Business Mailing Address
First Line	:	8115 CRADDOCK RD
Second Line	:
City	:	GREENBELT
State	:	MD
Zip	:	20770-3053
Country	:	US
Telephone Number	:	301-552-8708
Fax Number	:

Provider Business Practice Location Address
First Line	:	4555 OVERLOOK AVE SW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20375-0001
Country	:	US
Telephone Number	:	202-404-8430
Fax Number	:	202-404-8154

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

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	07/08/2007

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