Provider Demographics
NPI:1780909846
Name:WILLIAMS, NICOLA A
Entity type:Individual
Prefix:
First Name:NICOLA
Middle Name:A
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NICOLA
Other - Middle Name:A
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:3301 MOHEGAN AVE
Mailing Address - Street 2:
Mailing Address - City:MOHEGAN LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:10547-1716
Mailing Address - Country:US
Mailing Address - Phone:914-603-3420
Mailing Address - Fax:914-603-3420
Practice Address - Street 1:3301 MOHEGAN AVE
Practice Address - Street 2:
Practice Address - City:MOHEGAN LAKE
Practice Address - State:NY
Practice Address - Zip Code:10547-1716
Practice Address - Country:US
Practice Address - Phone:914-603-3420
Practice Address - Fax:914-603-3420
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY648198-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse