Provider Demographics
NPI:1063985505
Name:WILLIAMSON, TRACY LOUISE (RN)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:LOUISE
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 PANAMOKA TRL
Mailing Address - Street 2:
Mailing Address - City:RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:11961-2273
Mailing Address - Country:US
Mailing Address - Phone:631-294-4453
Mailing Address - Fax:
Practice Address - Street 1:111 PANAMOKA TRL
Practice Address - Street 2:
Practice Address - City:RIDGE
Practice Address - State:NY
Practice Address - Zip Code:11961-2273
Practice Address - Country:US
Practice Address - Phone:631-294-4453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY527081163WA0400X, 163WD0400X, 163WH0200X, 163WC0400X, 163WM1400X, 163WP0000X, 163WP0807X, 163WP0808X, 163WW0000X, 163WX1500X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)
No163WP0000XNursing Service ProvidersRegistered NursePain Management
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
No163WX1500XNursing Service ProvidersRegistered NurseOstomy Care