Healthcare Provider Details

I. General information

NPI: 1336116748
Provider Name (Legal Business Name): MOUSUMI MUKERJI RN, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 GRAND AVE STE D
SACRAMENTO CA
95838
US

IV. Provider business mailing address

1721 SHIRLEY DR
SACRAMENTO CA
95822-3064
US

V. Phone/Fax

Practice location:
  • Phone: 916-922-9868
  • Fax:
Mailing address:
  • Phone: 916-212-0324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95009054
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number595477
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number1553
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: