MEDICARE: MS. CAROL P WILLIAMS RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WS0200X	School Registered Nurse	655283-1	NY

General Provider Information

NPI Number	:	1366849853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROL P WILLIAMS RN

Provider Business Mailing Address
First Line	:	4811 39TH ST
Second Line	:
City	:	SUNNYSIDE
State	:	NY
Zip	:	11104-4513
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4811 39TH ST
Second Line	:
City	:	SUNNYSIDE
State	:	NY
Zip	:	11104-4513
Country	:	US
Telephone Number	:	718-937-3844
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/26/2014
Last Update Date	:	11/26/2014

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