Basic Information
| Provider Information | |||||||||
| NPI: | 1407346497 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALLEN-WILLIAMS | ||||||||
| FirstName: | CARMEYA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 650 MADISON ST | ||||||||
| Address2: | |||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132102319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154267680 | ||||||||
| FaxNumber: | 3154267798 | ||||||||
| Practice Location | |||||||||
| Address1: | 1017 BELLEVUE AVE | ||||||||
| Address2: | |||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132043915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154280320 | ||||||||
| FaxNumber: | 3154267798 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2018 | ||||||||
| LastUpdateDate: | 09/12/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 246518 | OH | Y | Nursing Service Providers | Licensed Practical Nurse |
ID Information
| ID | Type | State | Issuer | Description | 1407346497 | 05 | NY | MEDICAID | 246518 | 01 | NY | LICENCE PRACTICAL NURSE | OTHER |