Provider Demographics
NPI:1912988130
Name:WILLIAMS, ELAINE MARTHA (ANP)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:MARTHA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 304
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-0304
Mailing Address - Country:US
Mailing Address - Phone:518-747-3376
Mailing Address - Fax:518-747-8745
Practice Address - Street 1:325 MAIN ST
Practice Address - Street 2:HUDSON FALLS INTERNAL MEDICINE
Practice Address - City:HUDSON FALLS
Practice Address - State:NY
Practice Address - Zip Code:12839-1512
Practice Address - Country:US
Practice Address - Phone:518-747-3376
Practice Address - Fax:518-747-8745
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF302345363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00004337OtherRR MEDICARE
NY02329115Medicaid
NYCC1670Medicare PIN
P02506Medicare UPIN