Provider Demographics
NPI:1962469478
Name:WILLIAMS, MORDEANA MORQUITA (DNP, FNP)
Entity Type:Individual
Prefix:MRS
First Name:MORDEANA
Middle Name:MORQUITA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8556 262ND ST
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-1128
Mailing Address - Country:US
Mailing Address - Phone:718-831-1443
Mailing Address - Fax:
Practice Address - Street 1:8556 262ND ST
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-1128
Practice Address - Country:US
Practice Address - Phone:718-831-1443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332834363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02097203Medicaid
NY95N541Medicare PIN
NYP13318Medicare UPIN