Provider Demographics
NPI:1538746789
Name:GARCIA, WILLIANNY (RN)
Entity type:Individual
Prefix:
First Name:WILLIANNY
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 FEUSTAL ST
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-5101
Mailing Address - Country:US
Mailing Address - Phone:631-332-3262
Mailing Address - Fax:
Practice Address - Street 1:134 GREAT EAST NECK RD
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-8027
Practice Address - Country:US
Practice Address - Phone:631-332-3262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY765255163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY496101677OtherLICENSE