Healthcare Provider Details

I. General information

NPI: 1629423306
Provider Name (Legal Business Name): WHITNEY SHAW WILLIAMS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: WHITNEY SHAW TERRILL WHNP

II. Dates (important events)

Enumeration Date: 04/29/2016
Last Update Date: 10/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

443 CONGRESS ST FL 2
PORTLAND ME
04101-3531
US

IV. Provider business mailing address

784 HERCULES DR STE 110
COLCHESTER VT
05446-8049
US

V. Phone/Fax

Practice location:
  • Phone: 207-797-8881
  • Fax:
Mailing address:
  • Phone: 802-448-9755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number95004254
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: