Healthcare Provider Details

I. General information

NPI: 1104310853
Provider Name (Legal Business Name): JACQUELINE WILLIAMS, WHNP, A PROFESSIONAL NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2018
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 MALAGA COVE PLZ STE 203
PALOS VERDES ESTATES CA
90274-6813
US

IV. Provider business mailing address

407 N PACIFIC COAST HWY STE 508
REDONDO BEACH CA
90277-2872
US

V. Phone/Fax

Practice location:
  • Phone: 310-736-0489
  • Fax: 310-347-4376
Mailing address:
  • Phone: 310-736-0489
  • Fax: 310-347-4376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE DENISE WILLIAMS
Title or Position: PRESIDENT/NURSE PRACTITIONER
Credential: WHNP-BC
Phone: 310-736-0489