MEDICARE: CATHERINE D. WILLIAMS

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	163WC0400X	Case Management Registered Nurse	322793	NY
2	163WD1100X	Peritoneal Dialysis Registered Nurse	322793	NY
3	163WH0200X	Home Health Registered Nurse	322793	NY
4	163WN0300X	Nephrology Registered Nurse	322793	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	322793	OTHER	NY	RN LICENSE #

General Provider Information

NPI Number	:	1477921534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE D. WILLIAMS

Provider Business Mailing Address
First Line	:	1861 GRAND AVE
Second Line	:	UNIT A5
City	:	NORTH BALDWIN
State	:	NY
Zip	:	11510-2400
Country	:	US
Telephone Number	:	516-459-5266
Fax Number	:	516-608-5477

Provider Business Practice Location Address
First Line	:	1861 GRAND AVE APT A5
Second Line	:
City	:	NORTH BALDWIN
State	:	NY
Zip	:	11510-2412
Country	:	US
Telephone Number	:	516-459-5266
Fax Number	:	516-608-5477

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

Provider Enumeration Date	:	09/07/2015
Last Update Date	:	05/17/2026

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