Provider Demographics
NPI:1184221517
Name:JEWETT, CYNTHIA L (LM CPM)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:L
Last Name:JEWETT
Suffix:
Gender:F
Credentials:LM CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:358 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:ANGWIN
Mailing Address - State:CA
Mailing Address - Zip Code:94508-9723
Mailing Address - Country:US
Mailing Address - Phone:917-544-6547
Mailing Address - Fax:
Practice Address - Street 1:26990 COUNTY ROAD 95A
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-9443
Practice Address - Country:US
Practice Address - Phone:917-544-6547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA609176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife