JENIFER REZENDE SULLIVAN FNP NPI 1326501503

NPI Information

NPI: 1326501503
Provider Name: JENIFER REZENDE SULLIVAN, FNP
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

PECOS Registration: Yes

Address:
732 MOTT STREET
100-110
SAN FERNANDO, CA
ZIP 91340
Phone: (818) 963-5690
Get Directions

Jenifer Rezende Sullivan, FNP is a family nurse practitioner in San Fernando, CA with 6 years of experience. Jenifer Rezende Sullivan, FNP NPI is 1326501503. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

732 MOTT STREET
100-110
SAN FERNANDO, CA
ZIP 91340-237
Phone: (818) 963-5690

The NPI 1326501503 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 4/13/2019 and was last updated on 10/10/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family	95011562	CALIFORNIA	No
2	363LF0000X	Nurse Practitioner	Family	NP95011562	CALIFORNIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	95011562	MEDICAID	CALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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