Healthcare Provider Details

I. General information

NPI: 1134541287
Provider Name (Legal Business Name): KANEESHA J. WILLIAMS WHNP - BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2014
Last Update Date: 12/15/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W 30TH ST
LOS ANGELES CA
90007-3320
US

IV. Provider business mailing address

4003 1/2 LEEWARD AVE
LOS ANGELES CA
90005-3570
US

V. Phone/Fax

Practice location:
  • Phone: 323-213-3256
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number778225
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: