Provider Demographics
NPI:1518419985
Name:WILLIAMS, JENNIE (LPN)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 DENCARY LN
Mailing Address - Street 2:C
Mailing Address - City:ENDWELL
Mailing Address - State:NY
Mailing Address - Zip Code:13760-2393
Mailing Address - Country:US
Mailing Address - Phone:607-427-9923
Mailing Address - Fax:
Practice Address - Street 1:504 DENCARY LN
Practice Address - Street 2:C
Practice Address - City:ENDWELL
Practice Address - State:NY
Practice Address - Zip Code:13760-2393
Practice Address - Country:US
Practice Address - Phone:607-427-9923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307329164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse