Provider Demographics
NPI:1992469266
Name:RICKETTS-WILLIAMS, MARIE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:
Last Name:RICKETTS-WILLIAMS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-3844
Mailing Address - Country:US
Mailing Address - Phone:212-470-2584
Mailing Address - Fax:
Practice Address - Street 1:23 WILLOW ST
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-3844
Practice Address - Country:US
Practice Address - Phone:212-470-2584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-23
Last Update Date:2021-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY342774164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse