Provider Demographics
NPI:1174764187
Name:NAGEL, JESSICA LYNN WITTY (CNM)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN WITTY
Last Name:NAGEL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LYNN
Other - Last Name:WITTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 255228
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95865-5228
Mailing Address - Country:US
Mailing Address - Phone:530-750-5880
Mailing Address - Fax:530-750-5881
Practice Address - Street 1:2020 SUTTER PL
Practice Address - Street 2:SUITE 203
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-6213
Practice Address - Country:US
Practice Address - Phone:530-750-5880
Practice Address - Fax:530-750-5881
Is Sole Proprietor?:No
Enumeration Date:2009-03-20
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANM1852367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife