Provider Demographics
NPI:1871985267
Name:WILLIAMS, ELAINA (CPNP)
Entity type:Individual
Prefix:
First Name:ELAINA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13289
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27709-3289
Mailing Address - Country:US
Mailing Address - Phone:919-908-0376
Mailing Address - Fax:919-213-7003
Practice Address - Street 1:4024 STIRRUP CREEK DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-9464
Practice Address - Country:US
Practice Address - Phone:919-908-9730
Practice Address - Fax:919-213-7003
Is Sole Proprietor?:No
Enumeration Date:2015-02-23
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC241261363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics