1730229535 NPI number — DR. WANDA MILLNER WILLIAMS PHD, RN, WHNP

Table of content: DR. WANDA MILLNER WILLIAMS PHD, RN, WHNP (NPI 1730229535)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730229535 NPI number — DR. WANDA MILLNER WILLIAMS PHD, RN, WHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
WANDA
Provider Middle Name:
MILLNER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD, RN, WHNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THOMPSON
Provider Other First Name:
WANDA
Provider Other Middle Name:
MILLNER
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN, WHNP-BC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1730229535
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 22581
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10087-2581
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-669-6050
Provider Business Mailing Address Fax Number:
856-528-3117

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
317 S BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMDEN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08103-1209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-365-3519
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/08/2007

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: 363LW0102X , with the licence number:  26NJ00504800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LW0102X , with the licence number: 940025 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1730229535 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1730229535 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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