Provider Demographics
NPI:1508565318
Name:WILLIAMS-TALBERT, AUDESSEY
Entity Type:Individual
Prefix:
First Name:AUDESSEY
Middle Name:
Last Name:WILLIAMS-TALBERT
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 1:21 PEARSON DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01119-1479
Mailing Address - Country:US
Mailing Address - Phone:413-328-4635
Mailing Address - Fax:
Practice Address - Street 1:21 PEARSON DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01119-1479
Practice Address - Country:US
Practice Address - Phone:413-328-4635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2334804163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse