Healthcare Provider Details

I. General information

NPI: 1437313145
Provider Name (Legal Business Name): JUDITH MACWILLIAMS PUBLIC HEALTH NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2008
Last Update Date: 07/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 FRANKLIN ST
BUFFALO NY
14202-3925
US

IV. Provider business mailing address

76 HUNTWOOD CT
GETZVILLE NY
14068-1295
US

V. Phone/Fax

Practice location:
  • Phone: 716-961-6867
  • Fax:
Mailing address:
  • Phone: 716-689-4453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number299118-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: