Provider Demographics
NPI:1851553093
Name:WILLIAMS, ELIZABETH LARA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LARA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 MOHAWK DR
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-0525
Mailing Address - Country:US
Mailing Address - Phone:716-713-7463
Mailing Address - Fax:
Practice Address - Street 1:1001 BRINTON RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15221-4533
Practice Address - Country:US
Practice Address - Phone:412-501-0482
Practice Address - Fax:888-816-8109
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335392363LF0000X
PASP014675363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400005014Medicare PIN