Provider Demographics
NPI:1073186888
Name:WILLIAMS, ELLEN MARIE
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:MARIE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 MUDLICK RD.
Mailing Address - Street 2:
Mailing Address - City:HARDY
Mailing Address - State:KY
Mailing Address - Zip Code:41531
Mailing Address - Country:US
Mailing Address - Phone:304-601-0301
Mailing Address - Fax:
Practice Address - Street 1:627 MUDLICK RD.
Practice Address - Street 2:
Practice Address - City:HARDY
Practice Address - State:KY
Practice Address - Zip Code:41531
Practice Address - Country:US
Practice Address - Phone:304-601-0301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant