Healthcare Provider Details

I. General information

NPI: 1629558234
Provider Name (Legal Business Name): JHEANELL WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 08/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1067 BURKE AVE
BRONX NY
10469-3820
US

IV. Provider business mailing address

1067 BURKE AVE
BRONX NY
10469-3820
US

V. Phone/Fax

Practice location:
  • Phone: 914-441-6348
  • Fax:
Mailing address:
  • Phone: 914-441-6348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number714870
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: