Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP60869396 | WA |
N | 363LP2300X | Nurse Practitioner - Primary Care | AP60869396 | WA |
NPI | 1053807495 |
---|---|
Provider Name | Shenika Williams-Ollivierre |
First Address | Lakewood, WA 98499-3024 |
Second Address | Lakewood, WA 98499-3024 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2018 |
Last Update Date | 18/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2105973 | (05) | WA |