Provider Demographics
NPI:1336120195
Name:WILLIAMS, ANN BARTLEY (APRN)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:BARTLEY
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 YORK ST
Mailing Address - Street 2:NATHAN SMITH CLINIC
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3221
Mailing Address - Country:US
Mailing Address - Phone:203-688-5303
Mailing Address - Fax:203-688-3216
Practice Address - Street 1:15 YORK ST
Practice Address - Street 2:NATHAN SMITH CLINIC
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3221
Practice Address - Country:US
Practice Address - Phone:203-688-5303
Practice Address - Fax:203-688-3216
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000564363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q45233Medicare UPIN
CT500001491Medicare ID - Type Unspecified