Provider Demographics
NPI:1174602825
Name:WILLIAMS, MARY VIRGINIA (RN, MS, FNP)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:VIRGINIA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RN, MS, FNP
Other - Prefix:
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Mailing Address - Street 1:2565 CLARK LN
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-3042
Mailing Address - Country:US
Mailing Address - Phone:510-847-9187
Mailing Address - Fax:
Practice Address - Street 1:1776 YGNACIO VALLEY RD STE 208
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3125
Practice Address - Country:US
Practice Address - Phone:925-937-0995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA412931-6857363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner