Provider Demographics
NPI:1659020162
Name:WILLIAMS, CHIARINA SUSAN (FNP-C)
Entity Type:Individual
Prefix:
First Name:CHIARINA
Middle Name:SUSAN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 BRADSTREET AVE
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-4296
Mailing Address - Country:US
Mailing Address - Phone:781-420-4150
Mailing Address - Fax:
Practice Address - Street 1:129 BRADSTREET AVE
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-4296
Practice Address - Country:US
Practice Address - Phone:781-420-4150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2280678207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine