Healthcare Provider Details

I. General information

NPI: 1730229535
Provider Name (Legal Business Name): WANDA MILLNER WILLIAMS PHD, RN, WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: WANDA MILLNER THOMPSON RN, WHNP-BC

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 S BROADWAY
CAMDEN NJ
08103-1209
US

IV. Provider business mailing address

PO BOX 22581
NEW YORK NY
10087-2581
US

V. Phone/Fax

Practice location:
  • Phone: 856-365-3519
  • Fax:
Mailing address:
  • Phone: 856-669-6050
  • Fax: 856-528-3117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number26NJ00504800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number940025
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: