Provider Demographics
NPI:1134119506
Name:WILLIAMS, LAURIE ANN (NP)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:ANN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 FRANCIS ST.
Mailing Address - Street 2:SUITE 8E
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215
Mailing Address - Country:US
Mailing Address - Phone:617-632-1070
Mailing Address - Fax:617-632-1065
Practice Address - Street 1:110 FRANCIS ST.
Practice Address - Street 2:SUITE 8E
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215
Practice Address - Country:US
Practice Address - Phone:617-632-1070
Practice Address - Fax:617-632-1065
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207373363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0709239Medicaid
S48316Medicare UPIN
WI NP0870Medicare ID - Type Unspecified
MA0709239Medicaid