Basic Information
| Provider Information | |||||||||
| NPI: | 1154393460 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | JUDITH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3421 CONCORD RD | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174029001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7173392790 | ||||||||
| FaxNumber: | 7173392771 | ||||||||
| Practice Location | |||||||||
| Address1: | 40 V TWIN DR | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | GETTYSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 173257875 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7173392790 | ||||||||
| FaxNumber: | 7173392771 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2006 | ||||||||
| LastUpdateDate: | 01/24/2014 | ||||||||
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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 | 363LF0000X | UP006659B | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 1602661 | 01 | PA | GATEWAY MEDICARE ASSURED | OTHER | 2672921 | 01 | PA | HIGHMARK BLUE SHIELD - FREEDOM BLUE | OTHER |