Healthcare Provider Details

I. General information

NPI: 1285550947
Provider Name (Legal Business Name): MRS. LAURA LYNNE WILLLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 N CHEMUNG ST
WAVERLY NY
14892-1211
US

IV. Provider business mailing address

383 MCCOY RD
NICHOLS NY
13812-4523
US

V. Phone/Fax

Practice location:
  • Phone: 607-624-0167
  • Fax:
Mailing address:
  • Phone: 607-624-0167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberF360119
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: