Provider Demographics
NPI:1174081434
Name:WILLIAMS, KATHLEEN ESTELLE
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ESTELLE
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 1:7101 MINT PL APT 204
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-7153
Mailing Address - Country:US
Mailing Address - Phone:571-345-4658
Mailing Address - Fax:
Practice Address - Street 1:12045TH STREET NORTH EAST
Practice Address - Street 2:613
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019
Practice Address - Country:US
Practice Address - Phone:202-817-4876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide