Provider Demographics
NPI:1700549177
Name:NUNES, JEANETTE LENAY (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:LENAY
Last Name:NUNES
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9381 E STOCKTON BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-5070
Mailing Address - Country:US
Mailing Address - Phone:916-351-9400
Mailing Address - Fax:
Practice Address - Street 1:510 PLAZA DR STE 170
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-4790
Practice Address - Country:US
Practice Address - Phone:916-351-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015324363LF0000X, 363LP0808X
CA2022008170363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily