Provider Demographics
NPI:1871709378
Name:WILLIAMS, DEVELLE (APRN MSN FNP BC)
Entity type:Individual
Prefix:MS
First Name:DEVELLE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:APRN MSN FNP BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1667 BEDFORD CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:CA
Mailing Address - Zip Code:29223-5536
Mailing Address - Country:US
Mailing Address - Phone:803-309-8723
Mailing Address - Fax:
Practice Address - Street 1:16177 HESPERIAN BLVD STE C
Practice Address - Street 2:
Practice Address - City:SAN LORENZO
Practice Address - State:CA
Practice Address - Zip Code:94580-2451
Practice Address - Country:US
Practice Address - Phone:510-276-5558
Practice Address - Fax:510-276-5646
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1516363L00000X
CA23232363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1516OtherSTATE LICENSE APRN 1516
CA23232OtherNP CERTIFICATE
CA10574146OtherAACN
CA23232OtherNP CERTIFICATE