Healthcare Provider Details

I. General information

NPI: 1043440977
Provider Name (Legal Business Name): CAROLYN L WRAY-WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 01/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 1ST AVE
NEW YORK NY
10016-6401
US

IV. Provider business mailing address

545 1ST AVE
NEW YORK NY
10016-6401
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-8005
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number464034
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF305003
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberF305003
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: