Provider Demographics
NPI:1689897944
Name:WILLIAMS, LISA CARMELLA (ANP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:CARMELLA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:CARMELLA
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP
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:
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:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304529363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health