Provider Demographics
NPI:1790068484
Name:WILLIAMS, EBONY (CNA)
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 GATES AVE
Mailing Address - Street 2:2D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-1766
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:745 GATES AVE
Practice Address - Street 2:2D
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-1766
Practice Address - Country:US
Practice Address - Phone:917-995-6174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY34305286121376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide