Provider Demographics
NPI:1992237317
Name:WILLIAMS, STEPHANIE (NP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 15TH ST NW
Mailing Address - Street 2:SUITE 301
Mailing Address - City:NORTON
Mailing Address - State:VA
Mailing Address - Zip Code:24273-1627
Mailing Address - Country:US
Mailing Address - Phone:276-679-1623
Mailing Address - Fax:276-679-6811
Practice Address - Street 1:102 15TH ST NW
Practice Address - Street 2:SUITE 301
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273-1627
Practice Address - Country:US
Practice Address - Phone:276-679-1623
Practice Address - Fax:276-679-6811
Is Sole Proprietor?:No
Enumeration Date:2017-04-03
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174527363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily