Provider Demographics
NPI:1699134460
Name:WILLIAMS, JENNIFER (LPN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
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 1:944 KELLY ST
Mailing Address - Street 2:APT 4
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-4243
Mailing Address - Country:US
Mailing Address - Phone:347-978-4125
Mailing Address - Fax:
Practice Address - Street 1:944 KELLY ST
Practice Address - Street 2:APT 4
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-4243
Practice Address - Country:US
Practice Address - Phone:347-978-4125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10320386164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse