Provider Demographics
NPI:1841569332
Name:WILLIAMS, LEESHA E (RN)
Entity Type:Individual
Prefix:
First Name:LEESHA
Middle Name:E
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 1:20 OLD TURNPIKE RD
Mailing Address - Street 2:STE 307
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-2532
Mailing Address - Country:US
Mailing Address - Phone:845-624-0260
Mailing Address - Fax:
Practice Address - Street 1:20 OLD TURNPIKE RD
Practice Address - Street 2:STE 307
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-2532
Practice Address - Country:US
Practice Address - Phone:845-624-0260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY597342163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY597342OtherREGISTERED NURSE