Healthcare Provider Details

I. General information

NPI: 1649711813
Provider Name (Legal Business Name): SHAUTE WILLIAMS NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2017
Last Update Date: 08/17/2020
Certification Date: 08/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11500 BROOKSHIRE AVE
DOWNEY CA
90241-4917
US

IV. Provider business mailing address

814 FRANCISCO ST
LOS ANGELES CA
90017-2530
US

V. Phone/Fax

Practice location:
  • Phone: 562-904-5000
  • Fax: 562-904-5140
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number728063
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95008057
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: