Healthcare Provider Details

I. General information

NPI: 1235456732
Provider Name (Legal Business Name): SUSAN P. WILLIAMS RN, APN, C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 04/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 ROUTE 22
BRIDGEWATER NJ
08807-2405
US

IV. Provider business mailing address

540 ROUTE 22
BRIDGEWATER NJ
08807-2405
US

V. Phone/Fax

Practice location:
  • Phone: 908-722-1881
  • Fax:
Mailing address:
  • Phone: 908-722-1881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NO11636600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number26NJ00035300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: