Provider Demographics
NPI:1679824817
Name:WILLIAMS, KIMBERLY MONIQUE (RN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MONIQUE
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 1:22 FLEETWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:10977-7003
Mailing Address - Country:US
Mailing Address - Phone:845-362-7656
Mailing Address - Fax:
Practice Address - Street 1:22 FLEETWOOD AVE
Practice Address - Street 2:
Practice Address - City:CHESTNUT RIDGE
Practice Address - State:NY
Practice Address - Zip Code:10977-7003
Practice Address - Country:US
Practice Address - Phone:845-577-6170
Practice Address - Fax:845-426-1807
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY650684163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse