Basic Information
| Provider Information | |||||||||
| NPI: | 1023106622 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TINKELENBERG | ||||||||
| FirstName: | JUDITH | ||||||||
| MiddleName: | IRENE | ||||||||
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| Credential: | RN, CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4361 RAILROAD AVE STE H | ||||||||
| Address2: | |||||||||
| City: | PLEASANTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945666611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9254621755 | ||||||||
| FaxNumber: | 9254621650 | ||||||||
| Practice Location | |||||||||
| Address1: | 5925 W LAS POSITAS BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | PLEASANTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94588 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9254621755 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2006 | ||||||||
| LastUpdateDate: | 08/28/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | NMW538 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | NMW005381 | 05 | CA | MEDICAID |