Organization
SHASTA PRIMARY CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAUNI VONICE WILLIAMS FNP-C (RENDERING PROVIDER/FOUNDER)
(530) 949-7860
Entity
Organization
Contact information
Practice address
2121 AIRPARK DR, REDDING, CA 96001-2433
(530) 255-8025
(530) 255-8028
Mailing address
2121 AIRPARK DR, REDDING, CA 96001-2433
(530) 255-8025
(530) 255-8028
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1000694320
—
CA
01
—
202129410899
STATE FILE NUMBER
CA
05
—
CA376666
—
CA
Enumeration date
11/03/2021
Last updated
04/02/2023
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