Provider Demographics
NPI:1982314613
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
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:209-483-8303
Mailing Address - Fax:
Practice Address - Street 1:1649 COUNTRYSIDE DR
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-9528
Practice Address - Country:US
Practice Address - Phone:209-483-8303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCE NURSING PRACTICE MEDICAL GROUP, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care