Provider Demographics
NPI:1184616609
Name:WILLIAMS, KATHERINE WORRELL (NP)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:WORRELL
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:404 N CAYUGA ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-4219
Mailing Address - Country:US
Mailing Address - Phone:607-277-0969
Mailing Address - Fax:607-277-3242
Practice Address - Street 1:404 N CAYUGA ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-4219
Practice Address - Country:US
Practice Address - Phone:607-277-0969
Practice Address - Fax:607-277-3242
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF303419-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP48753Medicare UPIN