Healthcare Provider Details

I. General information

NPI: 1578953865
Provider Name (Legal Business Name): MELISSA GAIL WILLIAMS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2015
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CALLOWHILL ST STE 101
PHILADELPHIA PA
19123-3658
US

IV. Provider business mailing address

3300 HENRY AVE SUITE 500
PHILADELPHIA PA
19129-1121
US

V. Phone/Fax

Practice location:
  • Phone: 215-825-8220
  • Fax:
Mailing address:
  • Phone: 215-581-2046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP014736
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: