Provider Demographics
NPI:1235594763
Name:WILLIAMS, JOY (NP)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:
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 1:20 SHIP AVE APT 30
Mailing Address - Street 2:MEDFORD
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-7217
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55 FRUIT STREET
Practice Address - Street 2:INTERVENTIONAL RADIOLOGY ELLISON 210
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2622
Practice Address - Country:US
Practice Address - Phone:617-724-4289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-29
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MANP 153670363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care