Provider Demographics
NPI:1508632365
Name:WILLIAMS, LAUREN GRACE (AGACNP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:GRACE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 DARTMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-5126
Mailing Address - Country:US
Mailing Address - Phone:516-509-6480
Mailing Address - Fax:
Practice Address - Street 1:63 DARTMOUTH ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-5126
Practice Address - Country:US
Practice Address - Phone:516-509-6480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-01
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY432739363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care