Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 26NJ00810700 | NJ |
NPI | 1003311127 |
---|---|
Provider Name | Michael Anthony Williams-Healy |
First Address | Wayne, NJ 07470-5125 |
Second Address | Nutley, NJ 07110-3502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2018 |
Last Update Date | 29/03/2018 |