Provider Demographics
NPI:1962830836
Name:WILLIAMS, LYDIA A (FNP-BC, CRNP, CWOCN)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:A
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:FNP-BC, CRNP, CWOCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 MARKET ST
Mailing Address - Street 2:LM 500 WEST TOWER
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-2100
Mailing Address - Country:US
Mailing Address - Phone:215-985-2595
Mailing Address - Fax:
Practice Address - Street 1:1200 CALLOWHILL ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-3658
Practice Address - Country:US
Practice Address - Phone:215-825-8220
Practice Address - Fax:215-825-8254
Is Sole Proprietor?:No
Enumeration Date:2013-10-31
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN563858163W00000X
PASP012908363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse