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General NPI Number Information
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NPI Number | 1396819561
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Entity Type | Individual
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Provider Name | NANELLE LAVINIA JONES-SULLIVAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 06/08/2020
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Provider Practice Location Address
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Address Line | 1119 E MONTE VISTA AVE
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City | VACAVILLE
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State | CA
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Zip | 95688-3009
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Country | US
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Telephone | 707-469-4540
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Fax |
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Provider Business Mailing Address
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Address Line | 218 SANTA CRUZ CT
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City | VACAVILLE
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State | CA
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Zip | 95688-3559
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Country | US
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Telephone | 707-685-2061
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | G64660
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | G64660
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License Number State | CA
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