MEDICARE: ROSEMARIE ELAINE WILLIAMS LPN

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	164W00000X	Licensed Practical Nurse	291295	NY

General Provider Information

NPI Number	:	1861882516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSEMARIE ELAINE WILLIAMS LPN

Provider Business Mailing Address
First Line	:	11558 232ND ST
Second Line	:
City	:	CAMBRIA HEIGHTS
State	:	NY
Zip	:	11411-1414
Country	:	US
Telephone Number	:	718-525-8892
Fax Number	:

Provider Business Practice Location Address
First Line	:	11558 232ND ST
Second Line	:
City	:	CAMBRIA HEIGHTS
State	:	NY
Zip	:	11411-1414
Country	:	US
Telephone Number	:	718-525-8892
Fax Number	:

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

Provider Enumeration Date	:	02/03/2015
Last Update Date	:	04/14/2015

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