Provider Demographics
NPI:1396352928
Name:WILLIAMS, ALYSSA JOAN (LPN)
Entity type:Individual
Prefix:MS
First Name:ALYSSA
Middle Name:JOAN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9420 SKIDMORE AVE # 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-5442
Mailing Address - Country:US
Mailing Address - Phone:347-874-0029
Mailing Address - Fax:
Practice Address - Street 1:371 FORT WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-6739
Practice Address - Country:US
Practice Address - Phone:772-224-7640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY313936164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse