MEDICARE: MRS. CHARLA DIANNE WILLIAMS LPN

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	164W00000X	Licensed Practical Nurse	0002050267	VA

General Provider Information

NPI Number	:	1801172135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHARLA DIANNE WILLIAMS LPN

Provider Business Mailing Address
First Line	:	6436 MILL RIVER TRCE
Second Line	:
City	:	CHESTERFIELD
State	:	VA
Zip	:	23832-9237
Country	:	US
Telephone Number	:	804-912-5162
Fax Number	:

Provider Business Practice Location Address
First Line	:	6436 MILL RIVER TRCE
Second Line	:
City	:	CHESTERFIELD
State	:	VA
Zip	:	23832-9237
Country	:	US
Telephone Number	:	804-912-5162
Fax Number	:

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

Provider Enumeration Date	:	11/01/2011
Last Update Date	:	11/01/2011

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