Provider Demographics
NPI:1538562939
Name:WILLIAMS, ANGELA T (FNP-C)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:T
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 E ALBERTONI ST
Mailing Address - Street 2:#200-619
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-1425
Mailing Address - Country:US
Mailing Address - Phone:310-662-2052
Mailing Address - Fax:
Practice Address - Street 1:5245 PACIFIC CONCOURSE DR
Practice Address - Street 2:SUITE 129
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-6904
Practice Address - Country:US
Practice Address - Phone:310-662-2052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-30
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95000888363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily