Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 318213 | CA |
NPI | 1972649275 |
---|---|
Provider Name | Dr. Charlene Ruth Williams |
First Address | Placerville, CA 95667-9704 |
Second Address | Placerville, CA 95667-4200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 22/12/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AP957Z | PTAN (01) | CA |