Healthcare Provider Details

I. General information

NPI: 1295037570
Provider Name (Legal Business Name): RACHAEL BETH WENBAN LM CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2010
Last Update Date: 10/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5321 1/2 14TH AVE
SACRAMENTO CA
95820-3001
US

IV. Provider business mailing address

5321 1/2 14TH AVE
SACRAMENTO CA
95820-3001
US

V. Phone/Fax

Practice location:
  • Phone: 530-386-5517
  • Fax:
Mailing address:
  • Phone: 530-386-5517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberLM287
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: