MEDICARE: DANVILLEE CAMALA WILLIAMS R.N.

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	163WH0200X	Home Health Registered Nurse	635440	NY

General Provider Information

NPI Number	:	1770847691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANVILLEE CAMALA WILLIAMS R.N.

Provider Business Mailing Address
First Line	:	954 E 15TH ST APT 1D
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-3737
Country	:	US
Telephone Number	:	347-641-4235
Fax Number	:

Provider Business Practice Location Address
First Line	:	10411 120TH ST
Second Line	:
City	:	SOUTH RICHMOND HILL
State	:	NY
Zip	:	11419-2816
Country	:	US
Telephone Number	:	718-322-8121
Fax Number	:

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

Provider Enumeration Date	:	06/26/2012
Last Update Date	:	06/26/2012

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