Healthcare Provider Details

I. General information

NPI: 1043675747
Provider Name (Legal Business Name): JYESHA ISIS WREN CNM, WHNP, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2015
Last Update Date: 12/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2721 COMSTOCK CIR
BELMONT CA
94002-2904
US

IV. Provider business mailing address

2721 COMSTOCK CIR
BELMONT CA
94002-2904
US

V. Phone/Fax

Practice location:
  • Phone: 831-713-6602
  • Fax:
Mailing address:
  • Phone: 831-713-6602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number95003564
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number849517
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number235777
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: