=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619446572
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIA GEMMA WILLIAMS FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2018
-----------------------------------------------------
Last Update Date | 11/20/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1400 MACARTHUR BLVD
-----------------------------------------------------
City | MAHWAH
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07430-3618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-706-0238
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 108 GRAND ST
-----------------------------------------------------
City | NEW MILFORD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07646-2626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-394-9970
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 26NJ00839100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------