MEDICARE: WYTOSHERY MONEA WILLIAMS NURSE PRACTITIONER

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	95008480	CA

General Provider Information

NPI Number	:	1700385747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WYTOSHERY MONEA WILLIAMS NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	1475 ISLAND AVE UNIT 3901
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-8252
Country	:	US
Telephone Number	:	858-436-4850
Fax Number	:

Provider Business Practice Location Address
First Line	:	1111 6TH AVE # M07
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-5209
Country	:	US
Telephone Number	:	858-999-6948
Fax Number	:	858-724-3892

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

Provider Enumeration Date	:	02/05/2018
Last Update Date	:	03/16/2022

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