Basic Information
| Provider Information | |||||||||
| NPI: | 1912988130 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | ELAINE | ||||||||
| MiddleName: | MARTHA | ||||||||
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| Credential: | ANP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 304 | ||||||||
| Address2: | |||||||||
| City: | GLENS FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128010304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187473376 | ||||||||
| FaxNumber: | 5187478745 | ||||||||
| Practice Location | |||||||||
| Address1: | 325 MAIN ST | ||||||||
| Address2: | HUDSON FALLS INTERNAL MEDICINE | ||||||||
| City: | HUDSON FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128391512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187473376 | ||||||||
| FaxNumber: | 5187478745 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2005 | ||||||||
| LastUpdateDate: | 06/07/2012 | ||||||||
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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 | 363LA2200X | F302345 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | P00004337 | 01 | NY | RR MEDICARE | OTHER | 02329115 | 05 | NY | MEDICAID |