Provider Demographics
NPI:1356501712
Name:WILLIAMS, EUDORA PATRICIA
Entity Type:Individual
Prefix:MRS
First Name:EUDORA
Middle Name:PATRICIA
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 1:454 HAMRONY AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:15074
Mailing Address - Country:US
Mailing Address - Phone:724-728-0341
Mailing Address - Fax:724-728-0341
Practice Address - Street 1:454 HAMRONY AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:PA
Practice Address - Zip Code:15074
Practice Address - Country:US
Practice Address - Phone:724-728-0341
Practice Address - Fax:724-728-0341
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAQS001932846332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies