1760130504 NPI number — DE ANNE MARY WILLIAMS WHNP

Table of content: DE ANNE MARY WILLIAMS WHNP (NPI 1760130504)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760130504 NPI number — DE ANNE MARY WILLIAMS WHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
DE ANNE
Provider Middle Name:
MARY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
WHNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHRISTOPHER
Provider Other First Name:
DE ANNE
Provider Other Middle Name:
MARY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
WHNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1760130504
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2345 SKYLINE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BREA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92821-4542
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-392-1527
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 SUPERIOR AVE STE 310
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWPORT BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92663-3609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-644-2722
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/11/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LX0001X , with the licence number:  95019467 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 95019467 . This is a "FURNISHING LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com