Provider Demographics
NPI:1811477300
Name:WILLIAMS LUBATTI, HARLEY ELIZABETH
Entity type:Individual
Prefix:
First Name:HARLEY
Middle Name:ELIZABETH
Last Name:WILLIAMS LUBATTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HARLEY
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 BANNING ST STE 250
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-3492
Mailing Address - Country:US
Mailing Address - Phone:302-736-1320
Mailing Address - Fax:302-346-4532
Practice Address - Street 1:200 BANNING ST STE 250
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3492
Practice Address - Country:US
Practice Address - Phone:302-736-1320
Practice Address - Fax:302-346-4532
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
PAMA060015363A00000X, 363AM0700X
DEC5-0011766363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE250694487Medicaid