Healthcare Provider Details

I. General information

NPI: 1225205578
Provider Name (Legal Business Name): GRETCHEN WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 N 1ST ST
FRESNO CA
93726-2304
US

IV. Provider business mailing address

4440 N 1ST ST
FRESNO CA
93726-2304
US

V. Phone/Fax

Practice location:
  • Phone: 559-229-2000
  • Fax: 559-225-1030
Mailing address:
  • Phone: 559-229-2000
  • Fax: 559-225-1030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: