Provider Demographics
NPI:1275907537
Name:WILLIAMS, CAMILLE VERGINA I (RN)
Entity Type:Individual
Prefix:MRS
First Name:CAMILLE
Middle Name:VERGINA
Last Name:WILLIAMS
Suffix:I
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 STERLING ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-3416
Mailing Address - Country:US
Mailing Address - Phone:914-888-4693
Mailing Address - Fax:
Practice Address - Street 1:167 STERLING ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-3416
Practice Address - Country:US
Practice Address - Phone:914-888-4693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-23
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY708560-1251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYKY53054WMedicaid