Healthcare Provider Details

I. General information

NPI: 1659563864
Provider Name (Legal Business Name): JOAN MARIE PARTRIDGE RN, CNM, WHCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS JOAN MARIE D'AGOSTINO

II. Dates (important events)

Enumeration Date: 08/11/2007
Last Update Date: 12/05/2021
Certification Date: 12/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 MAGNOLIA AVE
RIVERSIDE CA
92505-3043
US

IV. Provider business mailing address

1295 STILLWATER RD
CORONA CA
92882-5843
US

V. Phone/Fax

Practice location:
  • Phone: 866-984-7483
  • Fax:
Mailing address:
  • Phone: 951-735-7646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number1749
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License NumberRN450366
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License NumberRN450366
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number17065
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: