Provider Demographics
NPI:1275368540
Name:WILLIAMS, WILMA LORRAINE
Entity type:Individual
Prefix:
First Name:WILMA
Middle Name:LORRAINE
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 1:701 E FRANKLIN ST STE 105
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23219-2502
Mailing Address - Country:US
Mailing Address - Phone:804-604-3009
Mailing Address - Fax:
Practice Address - Street 1:5453 BRADLEY PINES CIR APT F
Practice Address - Street 2:
Practice Address - City:SANDSTON
Practice Address - State:VA
Practice Address - Zip Code:23150-2337
Practice Address - Country:US
Practice Address - Phone:804-502-7493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1401081486374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide