Provider Demographics
NPI:1588118327
Name:WILLIAMS, ELITE ASHANTI (LPN)
Entity type:Individual
Prefix:
First Name:ELITE
Middle Name:ASHANTI
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 1:45 TWIN PINES DR APT 17A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11239-1807
Mailing Address - Country:US
Mailing Address - Phone:978-504-0576
Mailing Address - Fax:
Practice Address - Street 1:45 TWIN PINES DR APT 17A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11239-1807
Practice Address - Country:US
Practice Address - Phone:978-504-0576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NY3226711164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No101Y00000XBehavioral Health & Social Service ProvidersCounselor