Provider Demographics
NPI:1265803530
Name:WILLIAMS, ANDREA (RN, APRN)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RN, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CONGAREE CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29052-9713
Mailing Address - Country:US
Mailing Address - Phone:803-529-6351
Mailing Address - Fax:
Practice Address - Street 1:500 CONGAREE CHURCH RD
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:SC
Practice Address - Zip Code:29052-9713
Practice Address - Country:US
Practice Address - Phone:803-529-6351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-13
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC51082163WA2000X
SC20286363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health