Provider Demographics
NPI:1689432254
Name:WILLIAMS, TAMMY L (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:L
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:367 INGRAHAM HILL RD
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13903-5513
Mailing Address - Country:US
Mailing Address - Phone:607-222-3463
Mailing Address - Fax:
Practice Address - Street 1:367 INGRAHAM HILL RD
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13903-5513
Practice Address - Country:US
Practice Address - Phone:607-222-3463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-08
Last Update Date:2024-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY772131-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse