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General NPI Number Information
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NPI Number | 1639846140
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Entity Type | Individual
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Provider Name | BRITANE DERICA WILLIAMS FNP
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Gender | Female
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Dates
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Enumeration Date | 08/24/2021
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Last Update Date | 11/09/2021
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Provider Practice Location Address
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Address Line | 18077 CA HWY 18 SUITE 100
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City | APPLE VALLEY
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State | CA
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Zip | 92307
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Country | US
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Telephone | 760-246-6670
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Fax |
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Provider Business Mailing Address
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Address Line | 10964 ROBLE ST
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City | LOMA LINDA
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State | CA
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Zip | 92354-6112
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Country | US
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Telephone | 281-785-0323
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95018147
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License Number State | CA
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