Provider Demographics
NPI:1033939103
Name:OUELLETTE WILLIAMS, AMANDA KAREN
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:KAREN
Last Name:OUELLETTE WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 LONG BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-5062
Mailing Address - Country:US
Mailing Address - Phone:562-548-6500
Mailing Address - Fax:
Practice Address - Street 1:3210 LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-5062
Practice Address - Country:US
Practice Address - Phone:562-548-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95373569163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse