Mary Black-Williams, NP

Primary specialty

Women's Health Nurse PractitionerTaxonomy code 363LW0102X

License

231324 Issued in CA

Practice address

5050 San Bernardino St
Montclair, CA 91763-2326

Phone

(909) 626-2463

Fax

(909) 624-6297

NPI assigned

Oct 5, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

Interoperability endpoints

• Direct secure messaging: mary.blackwilliams.p1@direct.fpawomenshealth.nextgenshare.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1114013026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3050 E AIRPORT WAY",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908062404",
            "telephone_number": "562-432-6966",
            "fax_number": "562-426-4227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5050 SAN BERNARDINO ST",
            "city": "MONTCLAIR",
            "state": "CA",
            "postal_code": "917632326",
            "telephone_number": "909-626-2463",
            "fax_number": "909-624-6297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK-WILLIAMS",
        "first_name": "MARY",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "CA",
            "license": "231324",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL",
            "identifier": "RN2313240",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Women's Health Nurse Practitioner in Montclair, CA
• Providers in Montclair, CA by specialty
• Women's Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.