Provider Demographics
NPI:1710253232
Name:WILLIAMS, ELYSE (RN)
Entity Type:Individual
Prefix:
First Name:ELYSE
Middle Name:
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 1:65 COURT ST
Mailing Address - Street 2:102
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-4916
Mailing Address - Country:US
Mailing Address - Phone:718-452-2385
Mailing Address - Fax:
Practice Address - Street 1:65 COURT ST
Practice Address - Street 2:102
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4916
Practice Address - Country:US
Practice Address - Phone:718-452-2385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY552370163W00000X, 163WC1500X, 163WM0705X, 163WP2201X, 163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No163WS0200XNursing Service ProvidersRegistered NurseSchool