Provider Demographics
NPI:1942892815
Name:GWILLIAM, SCOTT (FNP-BC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:GWILLIAM
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BURR CT
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-5504
Mailing Address - Country:US
Mailing Address - Phone:801-367-1318
Mailing Address - Fax:
Practice Address - Street 1:3 BURR CT
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-5504
Practice Address - Country:US
Practice Address - Phone:801-367-1318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95016644363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily