MEDICARE: STEPHANIE NICOLE WILLIAMS RN

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	0001258850	VA
2	174H00000X	Health Educator	NA

General Provider Information

NPI Number	:	1801584156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE NICOLE WILLIAMS RN

Provider Business Mailing Address
First Line	:	300 CLIFFORD AVE
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22305-2707
Country	:	US
Telephone Number	:	571-263-6967
Fax Number	:	703-997-1394

Provider Business Practice Location Address
First Line	:	300 CLIFFORD AVE
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22305-2707
Country	:	US
Telephone Number	:	571-263-6967
Fax Number	:	703-997-1394

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

Provider Enumeration Date	:	04/25/2023
Last Update Date	:	04/27/2023

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