Healthcare Provider Details

I. General information

NPI: 1184388332
Provider Name (Legal Business Name): SUNNI ERIKA GESSEL PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2021
Last Update Date: 10/25/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13975 MONO WAY STE G
SONORA CA
95370-2824
US

IV. Provider business mailing address

13975 MONO WAY STE H
SONORA CA
95370-2824
US

V. Phone/Fax

Practice location:
  • Phone: 209-533-9600
  • Fax:
Mailing address:
  • Phone: 209-588-4640
  • Fax: 209-674-6219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95018928
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: