Provider Demographics
NPI:1437872868
Name:WILLIAMS, NICHOLA DIANE (FNP-BC)
Entity type:Individual
Prefix:
First Name:NICHOLA
Middle Name:DIANE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 EMERYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-1525
Mailing Address - Country:US
Mailing Address - Phone:919-414-4371
Mailing Address - Fax:
Practice Address - Street 1:1059 BEAVER CREEK COMMONS DR UNIT 230
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-3918
Practice Address - Country:US
Practice Address - Phone:984-960-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5016947363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care