Healthcare Provider Details

I. General information

NPI: 1770707481
Provider Name (Legal Business Name): JOAN MARIE VENEMAN NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 FLORIDA AVE
MODESTO CA
95350-4405
US

IV. Provider business mailing address

1118 WELLESLEY AVE
MODESTO CA
95350-5044
US

V. Phone/Fax

Practice location:
  • Phone: 209-576-3737
  • Fax: 209-576-3592
Mailing address:
  • Phone: 209-609-3683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number308874
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: