Healthcare Provider Details

I. General information

NPI: 1780183806
Provider Name (Legal Business Name): FATMATA WILLIAMS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2018
Last Update Date: 12/26/2025
Certification Date: 12/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

867 MAIN ST STE 3C-3
MANCHESTER CT
06040-6034
US

IV. Provider business mailing address

8 BEAR RIDGE DR
BLOOMFIELD CT
06002-1108
US

V. Phone/Fax

Practice location:
  • Phone: 413-237-2536
  • Fax: 959-223-2324
Mailing address:
  • Phone: 413-237-2536
  • Fax: 959-223-2324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number13018
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: