Provider Demographics
NPI:1790450815
Name:WILLIAMS, THOMAS EDWARD (RN)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:EDWARD
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 COCKRAM RD
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:NY
Mailing Address - Zip Code:14422-9741
Mailing Address - Country:US
Mailing Address - Phone:585-451-8423
Mailing Address - Fax:
Practice Address - Street 1:6900 COCKRAM RD
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:NY
Practice Address - Zip Code:14422-9741
Practice Address - Country:US
Practice Address - Phone:585-451-8423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY648372163WH0200X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WH0200XNursing Service ProvidersRegistered NurseHome Health