Individual provider Active NPI

Chanell S Williams, DNP, FNP, ENP

  • Nurse Practitioner
  • Newark, NJ
National Provider Identifier
1114779840
Registry record updated Apr 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
26NJ15130900 Issued in NJ
Practice address
150 Bergen St
Newark, NJ 07103
Phone
(973) 972-2676
NPI assigned
Apr 4, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 969889 NY
Registered Nurse 163W00000X 95295135 CA
Emergency Registered Nurse 163WE0003X 26NR19308300 NJ
Family Nurse Practitioner 363LF0000X 95034229 CA
Family Nurse Practitioner 363LF0000X F355672-01 NY
Nurse Practitioner 363L00000X 26NJ15130900 NJ Primary

Addresses

Primary practice location

150 Bergen St
Newark, NJ 07103

Mailing address

1 Clara Maass Dr
Belleville, NJ 07109-3550
Phone (908) 472-9609

Other practice location 1

26520 Cactus Ave
Moreno Valley, CA 92555-3927
Phone (951) 486-5644

Other practice location 2

1 Clara Maass Dr
Belleville, NJ 07109-3550
Phone (973) 450-2100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250917001083 NJ Practitioner - Nurse Practitioner 0840794509 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

162 Princeton Ave
Rahway, NJ 07065-1533

PO Box
Boston, MA 02241

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95295135CAMDRegistered Nurse
969889NYMDRegistered Nurse
26NR19308300NJMDEmergency Registered Nurse
95034229CAMDFamily Nurse Practitioner
F355672-01NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University Hospital CurrentSince Jul 8, 2025 Accepting new patients
University Hospital CurrentSince Jul 8, 2025 Accepting new patients
University Hospital Past Accepting new patients

Locations

150 Bergen St
Rm M219
Newark, NJ 07103
Phone (973) 972-1193

150 Bergen St
Newark, NJ 07103
Phone (973) 972-6056

Interoperability endpoints

  • FHIR API: https://epicproxy.et0434.epichosted.com/APIProxyPRD/UHNJ/api/FHIR/R4

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1712188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745366400000",
    "number": "1114779840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CLARA MAASS DR",
            "city": "BELLEVILLE",
            "state": "NJ",
            "postal_code": "071093550",
            "telephone_number": "908-472-9609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 BERGEN ST",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "07103",
            "telephone_number": "973-972-2676"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "26520 Cactus Ave",
            "address_purpose": "LOCATION",
            "city": "Moreno Valley",
            "state": "CA",
            "postal_code": "925553927",
            "country_code": "US",
            "telephone_number": "951-486-5644",
            "fax_number": "951-486-5876",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Clara Maass Dr",
            "address_purpose": "LOCATION",
            "city": "Belleville",
            "state": "NJ",
            "postal_code": "071093550",
            "country_code": "US",
            "telephone_number": "973-450-2100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "CHANELL",
        "middle_name": "S",
        "credential": "DNP, FNP, ENP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-04",
        "last_updated": "2025-04-23",
        "certification_date": "2025-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "969889",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "95295135",
            "primary": false
        },
        {
            "code": "163WE0003X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Emergency",
            "state": "NJ",
            "license": "26NR19308300",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95034229",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F355672-01",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NJ",
            "license": "26NJ15130900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, NJ

Sources for this page

Verify at the official NPI Registry.