Provider Demographics
NPI:1295094753
Name:WILLIAMS, PHYLLIS MARIA (RN)
Entity type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:MARIA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RN
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Mailing Address - Street 1:53 BEDFORD AVENUE
Mailing Address - Street 2:TRUMAN J. MOON PRIMARY CENTER
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-6498
Mailing Address - Country:US
Mailing Address - Phone:845-326-1775
Mailing Address - Fax:845-326-1789
Practice Address - Street 1:53 BEDFORD AVENUE
Practice Address - Street 2:TRUMAN J. MOON PRIMARY CENTER - NURSE'S OFFICE
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-6498
Practice Address - Country:US
Practice Address - Phone:845-326-1775
Practice Address - Fax:845-326-1789
Is Sole Proprietor?:No
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY382068-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool