Healthcare Provider Details

I. General information

NPI: 1275729147
Provider Name (Legal Business Name): ASSIA NICOLE WILLIAMS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 09/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

941 DURHAM RD
LANGHORNE PA
19047-5738
US

IV. Provider business mailing address

5 MCINTOSH RD
SEWELL NJ
08080-3035
US

V. Phone/Fax

Practice location:
  • Phone: 215-750-6161
  • Fax:
Mailing address:
  • Phone: 856-582-4195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN550437
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: