Healthcare Provider Details

I. General information

NPI: 1497695597
Provider Name (Legal Business Name): NICHOLE RENEE WILLIAMS-ARTRY CHW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13337 MOHAWK RD
APPLE VALLEY CA
92308-6496
US

IV. Provider business mailing address

13337 MOHAWK RD
APPLE VALLEY CA
92308-6496
US

V. Phone/Fax

Practice location:
  • Phone: 469-655-2345
  • Fax: 469-655-2345
Mailing address:
  • Phone: 469-655-2345
  • Fax: 469-655-2345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: