MEDICARE: MS. MARY VIRGINIA WILLIAMS RN, MS, FNP

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	363L00000X	Nurse Practitioner	412931-6857	CA

General Provider Information

NPI Number	:	1174602825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY VIRGINIA WILLIAMS RN, MS, FNP

Provider Business Mailing Address
First Line	:	2565 CLARK LN
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94597-3042
Country	:	US
Telephone Number	:	510-847-9187
Fax Number	:

Provider Business Practice Location Address
First Line	:	1776 YGNACIO VALLEY RD STE 208
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94598-3125
Country	:	US
Telephone Number	:	925-937-0995
Fax Number	:

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

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	02/21/2018

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