Provider Demographics
NPI:1629201256
Name:LISA C WILLIAMS MSN NURSE PRACTITIONER IN ADULT HEALTH PC
Entity Type:Organization
Organization Name:LISA C WILLIAMS MSN NURSE PRACTITIONER IN ADULT HEALTH PC
Other - Org Name:LISA C WILLIAMS P.C.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:CARMELLA
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:ANP
Authorized Official - Phone:516-223-4717
Mailing Address - Street 1:39 PORTERFIELD PL
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-3340
Mailing Address - Country:US
Mailing Address - Phone:516-223-4717
Mailing Address - Fax:516-223-4717
Practice Address - Street 1:39 PORTERFIELD PL
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-3340
Practice Address - Country:US
Practice Address - Phone:516-223-4717
Practice Address - Fax:516-223-4717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304529363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty