Provider Demographics
NPI:1336876754
Name:WILLIAMS, SUGI UTAMA (MSN, FNP-C, FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:SUGI
Middle Name:UTAMA
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MSN, FNP-C, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 MERCY AVE
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-8319
Mailing Address - Country:US
Mailing Address - Phone:209-564-5000
Mailing Address - Fax:
Practice Address - Street 1:333 MERCY AVE
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-8319
Practice Address - Country:US
Practice Address - Phone:209-201-6455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95020735363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner