Provider Demographics
NPI:1043787658
Name:WILLIAMS, ELIZABETH MICHELLE
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:MICHELLE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2407 WOODSTOCK AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15218-2628
Mailing Address - Country:US
Mailing Address - Phone:412-452-6304
Mailing Address - Fax:412-871-5906
Practice Address - Street 1:105 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15218-1521
Practice Address - Country:US
Practice Address - Phone:412-723-2999
Practice Address - Fax:412-871-5906
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA38563601251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health