Provider Demographics
NPI:1801063367
Name:WILLIAMS, VIVIAN WILSON (MSN RN CPNP)
Entity type:Individual
Prefix:MS
First Name:VIVIAN
Middle Name:WILSON
Last Name:WILLIAMS
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Gender:F
Credentials:MSN RN CPNP
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Mailing Address - Street 1:300 LONGWOOD AVE HUNNEWELL 3
Mailing Address - Street 2:CHILDRENS HOSPITAL BOSTON DEPARTMENT OF UROLOGY
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:617-355-7796
Mailing Address - Fax:617-730-0474
Practice Address - Street 1:300 LONGWOOD AVE HUNNEWELL 3
Practice Address - Street 2:CHILDRENS HOSPITAL BOSTON DEPARTMENT OF UROLOGY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-355-7796
Practice Address - Fax:617-730-0474
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2012-10-11
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Provider Licenses
StateLicense IDTaxonomies
MA262800363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics