Provider Demographics
NPI:1730229535
Name:WILLIAMS, WANDA MILLNER (PHD, RN, WHNP)
Entity type:Individual
Prefix:DR
First Name:WANDA
Middle Name:MILLNER
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PHD, RN, WHNP
Other - Prefix:MRS
Other - First Name:WANDA
Other - Middle Name:MILLNER
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, WHNP-BC
Mailing Address - Street 1:PO BOX 22581
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-2581
Mailing Address - Country:US
Mailing Address - Phone:856-669-6050
Mailing Address - Fax:856-528-3117
Practice Address - Street 1:317 S BROADWAY
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1209
Practice Address - Country:US
Practice Address - Phone:856-365-3519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00504800363LW0102X
NC940025363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1730229535Medicaid
NJ1730229535Medicaid