1205117934 NPI number — MRS. MARCHETTA RENA WILLIAMS LPN

Table of content: MRS. MARCHETTA RENA WILLIAMS LPN (NPI 1205117934)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205117934 NPI number — MRS. MARCHETTA RENA WILLIAMS LPN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
MARCHETTA
Provider Middle Name:
RENA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THOMAS
Provider Other First Name:
MARCHETTA
Provider Other Middle Name:
RENA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1205117934
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601
Provider Second Line Business Mailing Address:
CATHERINE ST APT 1
Provider Business Mailing Address City Name:
SYRACUSE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13203-1713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-849-6049
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601
Provider Second Line Business Practice Location Address:
CATHERINE ST APT 1
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13203-1713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-849-6049
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/08/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 164W00000X , with the licence number:  304527-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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