MEDICARE: JODY A 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	163WG0600X	Gerontology Registered Nurse	RN216532	MA
2	163WH0200X	Home Health Registered Nurse	RN216532	MA
3	163WP0200X	Pediatric Registered Nurse	RN216532	MA
4	163WG0000X	General Practice Registered Nurse	RN216532	MA

General Provider Information

NPI Number	:	1396342523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODY A WILLIAMS RN

Provider Business Mailing Address
First Line	:	156 CANTON ST
Second Line	:
City	:	STOUGHTON
State	:	MA
Zip	:	02072-2231
Country	:	US
Telephone Number	:	781-603-4522
Fax Number	:

Provider Business Practice Location Address
First Line	:	156 CANTON ST
Second Line	:
City	:	STOUGHTON
State	:	MA
Zip	:	02072-2231
Country	:	US
Telephone Number	:	781-603-4522
Fax Number	:

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

Provider Enumeration Date	:	10/01/2020
Last Update Date	:	10/01/2020

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