MEDICARE: TANIS WILLIAMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist	MPSS-WSAHRE	CA
2	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1154176147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANIS WILLIAMS

Provider Business Mailing Address
First Line	:	3800 WATT AVE STE 110
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95821-2622
Country	:	US
Telephone Number	:	916-344-0249
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 WATT AVE STE 110
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95821-2622
Country	:	US
Telephone Number	:	916-344-0249
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2024
Last Update Date	:	02/03/2026

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Directions to “ TANIS WILLIAMS ” Practice Location

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