Provider Demographics
NPI:1972649275
Name:WILLIAMS, CHARLENE RUTH (FNP, PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHARLENE
Middle Name:RUTH
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:FNP, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5221 DAVIDSON RD
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-9704
Mailing Address - Country:US
Mailing Address - Phone:530-642-2388
Mailing Address - Fax:
Practice Address - Street 1:670 PLACERVILLE DR STE 1B
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-4200
Practice Address - Country:US
Practice Address - Phone:530-621-6290
Practice Address - Fax:530-622-1293
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA318213363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAP957ZOtherPTAN