Provider Demographics
NPI:1578212643
Name:WILLIAMS, NATHANIEL NETE SIE SR
Entity Type:Individual
Prefix:MR
First Name:NATHANIEL
Middle Name:NETE SIE
Last Name:WILLIAMS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 UNION SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-5010
Mailing Address - Country:US
Mailing Address - Phone:845-826-2947
Mailing Address - Fax:
Practice Address - Street 1:3300 STREET RD APT H10
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-2015
Practice Address - Country:US
Practice Address - Phone:267-788-1176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA62053601372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion