Provider Demographics
NPI:1083492037
Name:WILLIAMS, MARY RITA
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:RITA
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 1:2545 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-3261
Mailing Address - Country:US
Mailing Address - Phone:814-455-0995
Mailing Address - Fax:814-455-0997
Practice Address - Street 1:2545 W 26TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-3261
Practice Address - Country:US
Practice Address - Phone:814-455-0995
Practice Address - Fax:814-455-0997
Is Sole Proprietor?:No
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker