Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC1500X | Nurse Practitioner - Community Health | F320057-1 | NY |
Y | 363LC1500X | Nurse Practitioner - Community Health | SP014759 | PA |
NPI | 1710057864 |
---|---|
Provider Name | Carey Marie Williams |
First Address | Johnson City, NY 13790-2558 |
Second Address | Montrose, PA 18801 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2006 |
Last Update Date | 06/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02722190 | (05) | NY |
1710057864 | NPI (01) | |
Q58690 | (02) |