Healthcare Provider Details

I. General information

NPI: 1144538836
Provider Name (Legal Business Name): SELINA A WILLIAMS RN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2010
Last Update Date: 07/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 MAIN ST
ISLIP NY
11751-3620
US

IV. Provider business mailing address

712 MAIN ST
ISLIP NY
11751-3620
US

V. Phone/Fax

Practice location:
  • Phone: 631-666-3939
  • Fax:
Mailing address:
  • Phone: 631-666-3939
  • Fax: 631-730-3467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number562964
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberF336693
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: