Provider Demographics
NPI:1760219158
Name:WILLIAMS, STAR
Entity type:Individual
Prefix:
First Name:STAR
Middle Name:
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 1:8822 MONITOR WAY
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23503-4625
Mailing Address - Country:US
Mailing Address - Phone:804-956-1501
Mailing Address - Fax:
Practice Address - Street 1:999 WATERSIDE DR STE 2525
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-3316
Practice Address - Country:US
Practice Address - Phone:804-956-1501
Practice Address - Fax:757-330-1010
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAD5H9N8C6246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy