Healthcare Provider Details

I. General information

NPI: 1962786921
Provider Name (Legal Business Name): EULALEE E WILLIAMS REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2011
Last Update Date: 10/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 LINDA AVE
HAWTHORNE NY
10532-2050
US

IV. Provider business mailing address

76 JUDITH LN
WATERBURY CT
06704-1930
US

V. Phone/Fax

Practice location:
  • Phone: 914-773-7423
  • Fax:
Mailing address:
  • Phone: 203-575-1289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number495804
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: