Provider Demographics
NPI:1538459805
Name:WILLIAMS, ANDREA DENISE (RN)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:DENISE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5101 97TH ST
Mailing Address - Street 2:APT 3
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-3033
Mailing Address - Country:US
Mailing Address - Phone:434-989-7877
Mailing Address - Fax:
Practice Address - Street 1:5101 97TH ST
Practice Address - Street 2:APT 3
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-3033
Practice Address - Country:US
Practice Address - Phone:434-989-7877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY640421-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse