Provider Demographics
NPI:1205320959
Name:WILLIAMS, JACQUELINE DENISE (WHNP-BC)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:DENISE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 N PACIFIC COAST HWY STE 508
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-2872
Mailing Address - Country:US
Mailing Address - Phone:310-736-0489
Mailing Address - Fax:310-347-4276
Practice Address - Street 1:407 N PACIFIC COAST HWY STE 508
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-2872
Practice Address - Country:US
Practice Address - Phone:310-736-0489
Practice Address - Fax:310-347-4276
Is Sole Proprietor?:No
Enumeration Date:2018-06-17
Last Update Date:2024-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95032876363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health