Healthcare Provider Details

I. General information

NPI: 1487386009
Provider Name (Legal Business Name): JOCELYN SANDERS CNM/WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2022
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 DALE RD
MODESTO CA
95356-9718
US

IV. Provider business mailing address

1412 STETSON AVE
MODESTO CA
95350-4021
US

V. Phone/Fax

Practice location:
  • Phone: 209-735-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number236283
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: