Healthcare Provider Details

I. General information

NPI: 1679201404
Provider Name (Legal Business Name): JACOB RILEY DEWEES DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 06/21/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 X ST
SACRAMENTO CA
95817-2214
US

IV. Provider business mailing address

4301 X ST
SACRAMENTO CA
95817-2214
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-2011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95022172
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number10003801
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: