Provider Demographics
NPI:1851455372
Name:WILLIAMS, CHARLES WAYNE (CNS,NP)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WAYNE
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:CNS,NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5040 BRABANT CT
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-3295
Mailing Address - Country:US
Mailing Address - Phone:916-752-1273
Mailing Address - Fax:916-676-4865
Practice Address - Street 1:5040 BRABANT CT
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-3295
Practice Address - Country:US
Practice Address - Phone:916-752-1273
Practice Address - Fax:916-676-4865
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2008-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACNS1514364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACNS015140Medicaid
P67986Medicare UPIN
ZZZ23857ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
ZZZ23857ZMedicare PIN