Provider Demographics
NPI:1528564390
Name:WILLIAMS, DONNA MICHELLE
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:MICHELLE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 BATES AVE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-1208
Mailing Address - Country:US
Mailing Address - Phone:925-390-6677
Mailing Address - Fax:
Practice Address - Street 1:2500 BATES AVE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-1208
Practice Address - Country:US
Practice Address - Phone:925-390-6677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9831363LF0000X
CA404663163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9831OtherBOARD OF REGISTERED NURSING
CA404663OtherBOARD OF REGISTERED NURSING