Healthcare Provider Details

I. General information

NPI: 1891604500
Provider Name (Legal Business Name): JENNIFER WHITNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3117 BONNIE LN
STOCKTON CA
95204-3647
US

IV. Provider business mailing address

710 N YOSEMITE ST
STOCKTON CA
95203-2733
US

V. Phone/Fax

Practice location:
  • Phone: 209-483-5797
  • Fax:
Mailing address:
  • Phone: 209-483-9918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number7034063740
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: