Provider Demographics
NPI:1548576739
Name:WILLIAMS, MARCIA ELAINE (LPN)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:ELAINE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 GILLEN PL
Mailing Address - Street 2:
Mailing Address - City:MASTIC
Mailing Address - State:NY
Mailing Address - Zip Code:11950-4249
Mailing Address - Country:US
Mailing Address - Phone:631-395-1971
Mailing Address - Fax:631-395-1971
Practice Address - Street 1:6 GILLEN PL
Practice Address - Street 2:
Practice Address - City:MASTIC
Practice Address - State:NY
Practice Address - Zip Code:11950-4249
Practice Address - Country:US
Practice Address - Phone:631-395-1971
Practice Address - Fax:631-395-1971
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY279767-1164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse