Provider Demographics
NPI:1841526134
Name:YORK, JONNIE (RN, PHN)
Entity type:Individual
Prefix:MS
First Name:JONNIE
Middle Name:
Last Name:YORK
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 BRANDI WAY
Mailing Address - Street 2:
Mailing Address - City:DENAIR
Mailing Address - State:CA
Mailing Address - Zip Code:95316
Mailing Address - Country:US
Mailing Address - Phone:209-632-0821
Mailing Address - Fax:
Practice Address - Street 1:251 E. HACKETT ROAD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95353
Practice Address - Country:US
Practice Address - Phone:209-558-2033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-22
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA276750163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse