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NPI Code Detail

MEDICARE: JESSICA VERMEULEN

MEDICARE: JESSICA VERMEULEN
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner22053CA

General Provider Information

NPI Number : 1417234410
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA VERMEULEN
Provider Business Mailing Address
First Line : 3835 N FREEWAY BLVD STE 100
Second Line :
City : SACRAMENTO
State : CA
Zip : 95834-1954
Country : US
Telephone Number : 916-576-7900
Fax Number :
Provider Business Practice Location Address
First Line : 514 N PROSPECT AVE STE 300
Second Line :
City : REDONDO BEACH
State : CA
Zip : 90277-3037
Country : US
Telephone Number : 855-501-1004
Fax Number : 626-689-4851
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2011
Last Update Date : 03/10/2025

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Directions to “ JESSICA VERMEULEN ” Practice Location

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