Provider Demographics
NPI:1801172135
Name:WILLIAMS, CHARLA DIANNE (LPN)
Entity type:Individual
Prefix:MRS
First Name:CHARLA
Middle Name:DIANNE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6436 MILL RIVER TRCE
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-9237
Mailing Address - Country:US
Mailing Address - Phone:804-912-5162
Mailing Address - Fax:
Practice Address - Street 1:6436 MILL RIVER TRCE
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-9237
Practice Address - Country:US
Practice Address - Phone:804-912-5162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002050267164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse