Provider Demographics
NPI:1871300301
Name:ADVANCE NURSING PRACTICE MEDICAL GROUP INC
Entity type:Organization
Organization Name:ADVANCE NURSING PRACTICE MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSELYN
Authorized Official - Middle Name:ARANDIA
Authorized Official - Last Name:DECULING
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:209-531-8650
Mailing Address - Street 1:600 WALNUT WOODS CT
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-9656
Mailing Address - Country:US
Mailing Address - Phone:209-567-2576
Mailing Address - Fax:209-567-2591
Practice Address - Street 1:809 SYLVAN AVE STE 400
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-1500
Practice Address - Country:US
Practice Address - Phone:209-567-2576
Practice Address - Fax:209-567-2591
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCE NURSING PRACTICE MEDICAL GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty