Provider Demographics
NPI:1447238894
Name:WILLIAMS, SUZAN HILLAIRE (ANP)
Entity Type:Individual
Prefix:
First Name:SUZAN
Middle Name:HILLAIRE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:SUZY
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ANP
Mailing Address - Street 1:575 PRICE ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-2553
Mailing Address - Country:US
Mailing Address - Phone:805-773-0707
Mailing Address - Fax:805-773-2051
Practice Address - Street 1:575 PRICE STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-6955
Practice Address - Country:US
Practice Address - Phone:805-773-0707
Practice Address - Fax:805-773-2051
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN392618363LA2200X
CA392618363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ50058Medicare UPIN
CAWNP5349AMedicare ID - Type Unspecified