Healthcare Provider Details

I. General information

NPI: 1063783066
Provider Name (Legal Business Name): CAROL LYNN WILLIAMS RN, MSN-FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2012
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1144 65TH ST STE F
OAKLAND CA
94608-1053
US

IV. Provider business mailing address

PO BOX 511250
LOS ANGELES CA
90051-7805
US

V. Phone/Fax

Practice location:
  • Phone: 510-929-1400
  • Fax: 510-929-1414
Mailing address:
  • Phone: 510-929-1400
  • Fax: 510-929-1414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95002798
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number784478
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: