Provider Demographics
NPI:1215650809
Name:WILLIAMS, DELLA ANN
Entity type:Individual
Prefix:
First Name:DELLA
Middle Name:ANN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-2653
Mailing Address - Country:US
Mailing Address - Phone:304-252-8070
Mailing Address - Fax:304-252-8073
Practice Address - Street 1:196 JESSUP HOLLOW RD
Practice Address - Street 2:
Practice Address - City:SOPHIA
Practice Address - State:WV
Practice Address - Zip Code:25921
Practice Address - Country:US
Practice Address - Phone:304-673-8826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22202164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse