Healthcare Provider Details

I. General information

NPI: 1871145425
Provider Name (Legal Business Name): MADELEINE SHERNOCK CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2019
Last Update Date: 02/09/2020
Certification Date: 02/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 47TH AVE STE 5
SACRAMENTO CA
95824-3848
US

IV. Provider business mailing address

4500 47TH AVE STE 5
SACRAMENTO CA
95824-3848
US

V. Phone/Fax

Practice location:
  • Phone: 916-668-9467
  • Fax: 209-336-6814
Mailing address:
  • Phone: 916-668-9467
  • Fax: 209-336-6814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name: MADELEINE JUSTINE WISNER
Title or Position: LICENSED MIDWIFE
Credential: LM
Phone: 916-668-9467