Provider Demographics
NPI:1063656205
Name:WILLIAMS, STEPHANIE G (NP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:G
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02465-1237
Mailing Address - Country:US
Mailing Address - Phone:878-992-2144
Mailing Address - Fax:
Practice Address - Street 1:687 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-1518
Practice Address - Country:US
Practice Address - Phone:508-222-3200
Practice Address - Fax:508-342-1903
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA273596363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110177174AMedicaid