Provider Demographics
NPI:1174025886
Name:WILLIAMS, DIANA LYNNE (FNP)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:LYNNE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12923 LEFLOSS AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-2548
Mailing Address - Country:US
Mailing Address - Phone:562-234-1834
Mailing Address - Fax:
Practice Address - Street 1:4288 KATELLA AVE
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3562
Practice Address - Country:US
Practice Address - Phone:562-256-8514
Practice Address - Fax:562-296-8561
Is Sole Proprietor?:No
Enumeration Date:2018-03-08
Last Update Date:2018-04-05
Deactivation Date:2018-03-12
Deactivation Code:
Reactivation Date:2018-04-05
Provider Licenses
StateLicense IDTaxonomies
CA95008594363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily