Active NPI
Gloria Jeanne Williams, CDP
- Community Health Worker
- Vancouver, WA
National Provider Identifier
1477712941
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- CP60026470
- Practice address
- 1601 E Fourth Plain Blvd
Vancouver, WA 98661-3753 - Phone
- (360) 397-4286
- Fax
- (360) 397-8450
- NPI assigned
- Jun 9, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | CP60026470 | WA | Primary |
Addresses
Primary practice location
1601 E Fourth Plain Blvd
Vancouver, WA 98661-3753
Mailing address
PO Box 1678
Vancouver, WA 98668-1678
Phone (360) 397-4286
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| RC00055291 | Other | WA | CHEMICAL DEPENDENCY PROFESSIONAL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CP60026470 | WA | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1212969600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1370908800000",
"number": "1477712941",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1678",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986681678",
"telephone_number": "360-397-4286",
"fax_number": "360-397-8450"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1601 E FOURTH PLAIN BLVD",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986613753",
"telephone_number": "360-397-4286",
"fax_number": "360-397-8450"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIAMS",
"first_name": "GLORIA",
"middle_name": "JEANNE",
"name_prefix": "Ms.",
"credential": "CDP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-06-09",
"last_updated": "2013-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "WA",
"license": "CP60026470",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHEMICAL DEPENDENCY PROFESSIONAL",
"identifier": "RC00055291",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Vancouver, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.