Healthcare Provider Details

I. General information

NPI: 1851881759
Provider Name (Legal Business Name): MICHELE WILLIAMS REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2018
Last Update Date: 05/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NOYES ST
UTICA NY
13502-3854
US

IV. Provider business mailing address

13B SCOTT ST
UTICA NY
13501-4717
US

V. Phone/Fax

Practice location:
  • Phone: 315-738-3800
  • Fax:
Mailing address:
  • Phone: 315-368-5744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number718840
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: