Ireta J Williams, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

14309-3 Issued in NY

Practice address

150 Hill St
Mahopac, NY 10541-2716

Phone

(845) 628-6427

Fax

(845) 208-3427

NPI assigned

May 21, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1179705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1942418942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 OLIVER AVE",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106032018",
            "telephone_number": "914-428-8158",
            "fax_number": "845-208-3427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 HILL ST",
            "city": "MAHOPAC",
            "state": "NY",
            "postal_code": "105412716",
            "telephone_number": "845-628-6427",
            "fax_number": "845-208-3427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "IRETA",
        "middle_name": "J",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "14309-3",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02376589",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Nagi Wissa
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• Amy Zallo

• Licensed Practical Nurse in Mahopac, NY
• Providers in Mahopac, NY by specialty
• Licensed Practical Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.