Active NPI
Susan Maria Lavelle, NP
- Community Health Nurse Practitioner
- Guerneville, CA
National Provider Identifier
1124226931
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Nurse Practitioner
- License
- NP 17209
- Practice address
- 16319 Third Street
Guerneville, CA 95446 - Phone
- (707) 869-2849
- Fax
- (707) 869-1477
- NPI assigned
- Jul 3, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Nurse Practitioner | 363LC1500X | NP 17209 | CA | Primary |
Addresses
Primary practice location
16319 Third Street
Guerneville, CA 95446
Mailing address
8690 Petaluma Hill Rd
Penngrove, CA 94951-8734
Phone (707) 992-0030
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
- Opted out of Medicare
- Yes, effective Sep 21, 2022 through Sep 21, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NP 17209 | CA | MD | Community Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1183420800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1124226931",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8690 PETALUMA HILL RD",
"city": "PENNGROVE",
"state": "CA",
"postal_code": "949518734",
"telephone_number": "707-992-0030"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16319 THIRD STREET",
"city": "GUERNEVILLE",
"state": "CA",
"postal_code": "95446",
"telephone_number": "707-869-2849",
"fax_number": "707-869-1477"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAVELLE",
"first_name": "SUSAN",
"middle_name": "MARIA",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-07-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363LC1500X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Community Health",
"state": "CA",
"license": "NP 17209",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Guerneville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.