Healthcare Provider Details

I. General information

NPI: 1093870701
Provider Name (Legal Business Name): MARJORIE ROSE WILLIAMS APRN, PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 MAIN ST 4TH FL
SPRINGFIELD MA
01107-1112
US

IV. Provider business mailing address

280 CHESTNUT ST 2ND FL
SPRINGFIELD MA
01199-1001
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-7284
  • Fax: 413-794-7140
Mailing address:
  • Phone: 413-794-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number120015
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License Number120015
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: