Healthcare Provider Details

I. General information

NPI: 1174764187
Provider Name (Legal Business Name): JESSICA LYNN WITTY NAGEL CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA LYNN WITTY

II. Dates (important events)

Enumeration Date: 03/20/2009
Last Update Date: 06/01/2022
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 SUTTER PL SUITE 203
DAVIS CA
95616-6213
US

IV. Provider business mailing address

PO BOX 255228
SACRAMENTO CA
95865-5228
US

V. Phone/Fax

Practice location:
  • Phone: 530-750-5880
  • Fax: 530-750-5881
Mailing address:
  • Phone: 530-750-5880
  • Fax: 530-750-5881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberNM1852
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: