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NPI Code Detail

MEDICARE: DR. NANELLE LAVINIA JONES-SULLIVAN M.D.

MEDICARE:  DR. NANELLE LAVINIA JONES-SULLIVAN  M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry PhysicianG64660CA
22084P0804XChild & Adolescent Psychiatry PhysicianG64660CA

General Provider Information

NPI Number : 1396819561
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NANELLE LAVINIA JONES-SULLIVAN M.D.
Provider Business Mailing Address
First Line : 218 SANTA CRUZ CT
Second Line :
City : VACAVILLE
State : CA
Zip : 95688-3559
Country : US
Telephone Number : 707-685-2061
Fax Number :
Provider Business Practice Location Address
First Line : 1119 E MONTE VISTA AVE
Second Line :
City : VACAVILLE
State : CA
Zip : 95688-3009
Country : US
Telephone Number : 707-469-4540
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/20/2006
Last Update Date : 06/08/2020

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