Provider Demographics
NPI:1992038053
Name:WILLIAMS, URSULA ANNELL (ACNP)
Entity Type:Individual
Prefix:MS
First Name:URSULA
Middle Name:ANNELL
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7980 STATE ROUTE 12
Mailing Address - Street 2:
Mailing Address - City:BARNEVELD
Mailing Address - State:NY
Mailing Address - Zip Code:13304-2536
Mailing Address - Country:US
Mailing Address - Phone:315-624-8440
Mailing Address - Fax:315-624-8450
Practice Address - Street 1:7980 STATE ROUTE 12
Practice Address - Street 2:
Practice Address - City:BARNEVELD
Practice Address - State:NY
Practice Address - Zip Code:13304-2536
Practice Address - Country:US
Practice Address - Phone:315-624-8440
Practice Address - Fax:315-624-8450
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF439489363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000420517001OtherBSH NE NY
NY9042146OtherMVP HEALTHPLAN
NYJ400018740Medicare PIN