Healthcare Provider Details

I. General information

NPI: 1760130504
Provider Name (Legal Business Name): DE ANNE MARY WILLIAMS WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DE ANNE MARY CHRISTOPHER WHNP

II. Dates (important events)

Enumeration Date: 03/11/2022
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SUPERIOR AVE STE 310
NEWPORT BEACH CA
92663-3609
US

IV. Provider business mailing address

2345 SKYLINE DR
BREA CA
92821-4542
US

V. Phone/Fax

Practice location:
  • Phone: 949-644-2722
  • Fax:
Mailing address:
  • Phone: 714-392-1527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number95019467
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: