MEDICARE: MRS. CARLETTA C WILLIAMS FNP-C

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	363LF0000X	Family Nurse Practitioner	26919	WV
2	363LF0000X	Family Nurse Practitioner	14241	OH

General Provider Information

NPI Number	:	1396080313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CARLETTA C WILLIAMS FNP-C

Provider Business Mailing Address
First Line	:	3622 BELMONT AVE STE 20
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44505-1444
Country	:	US
Telephone Number	:	348-550-0612
Fax Number	:	234-855-0062

Provider Business Practice Location Address
First Line	:	3622 BELMONT AVE STE 20
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44505-1444
Country	:	US
Telephone Number	:	348-550-0612
Fax Number	:	348-550-0622

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

Provider Enumeration Date	:	12/02/2012
Last Update Date	:	07/04/2024

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