Healthcare Provider Details

I. General information

NPI: 1851575492
Provider Name (Legal Business Name): MRS. GLORIANNE ELIZABETH WESSELS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2007
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5362 LEMEE LANE
MARIPOSA CA
95338-7104
US

IV. Provider business mailing address

5362 LEMEE LANE
MARIPOSA CA
95338-7104
US

V. Phone/Fax

Practice location:
  • Phone: 209-840-8212
  • Fax:
Mailing address:
  • Phone: 209-742-0884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: