Healthcare Provider Details

I. General information

NPI: 1437393253
Provider Name (Legal Business Name): CINDY-ANNE CARLA WILLIAMS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2009
Last Update Date: 04/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1052 LIBERTY AVE
BROOKLYN NY
11208-2913
US

IV. Provider business mailing address

763-5 EASTERN PARKWAY APT E-17
BROOKLYN NY
11213
US

V. Phone/Fax

Practice location:
  • Phone: 631-816-8054
  • Fax:
Mailing address:
  • Phone: 631-816-8054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number578668-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP018573
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number342833
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number342833
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: