Healthcare Provider Details

I. General information

NPI: 1164987335
Provider Name (Legal Business Name): MARY SPONSLER MSN, APRN, CNM, PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2019
Last Update Date: 04/24/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16575 DRAPER MINE RD
SONORA CA
95370-8430
US

IV. Provider business mailing address

19445 SOULSBYVILLE RD
SOULSBYVILLE CA
95372-9742
US

V. Phone/Fax

Practice location:
  • Phone: 209-533-2300
  • Fax: 209-533-4300
Mailing address:
  • Phone: 209-288-8726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberNMW236534
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN481611
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: