Provider Demographics
NPI:1760130504
Name:WILLIAMS, DE ANNE MARY (WHNP)
Entity Type:Individual
Prefix:
First Name:DE ANNE
Middle Name:MARY
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:DE ANNE
Other - Middle Name:MARY
Other - Last Name:CHRISTOPHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WHNP
Mailing Address - Street 1:2345 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-4542
Mailing Address - Country:US
Mailing Address - Phone:714-392-1527
Mailing Address - Fax:
Practice Address - Street 1:500 SUPERIOR AVE STE 310
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3609
Practice Address - Country:US
Practice Address - Phone:949-644-2722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-11
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95019467363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95019467OtherFURNISHING LICENSE