Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 0001269353 | VA |
NPI | 1083181309 |
---|---|
Provider Name | Quantia Shenae Williford |
First Address | Newport News, VA 23601-2474 |
Second Address | Newport News, VA 23601-2474 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2018 |
Last Update Date | 24/10/2018 |