Healthcare Provider Details

I. General information

NPI: 1346607249
Provider Name (Legal Business Name): KATHLEEN WILLIAMS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2016
Last Update Date: 01/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 SAINT GEORGE RD
STATEN ISLAND NY
10306-1516
US

IV. Provider business mailing address

201 SAINT GEORGE RD
STATEN ISLAND NY
10306-1516
US

V. Phone/Fax

Practice location:
  • Phone: 718-667-6407
  • Fax:
Mailing address:
  • Phone: 718-667-6407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number396221
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: