Healthcare Provider Details

I. General information

NPI: 1750309084
Provider Name (Legal Business Name): NYASHA WILLIAMS REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 09/10/2023
Certification Date: 09/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

781 OCEAN AVE APT 7
BROOKLYN NY
11226-4915
US

IV. Provider business mailing address

110 W 97TH ST
NEW YORK NY
10025-6450
US

V. Phone/Fax

Practice location:
  • Phone: 120-174-4457
  • Fax: 201-744-4575
Mailing address:
  • Phone: 212-316-7923
  • Fax: 212-316-7945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number737983-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number080058-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: