Provider Demographics
NPI:1447361845
Name:WASSON, DEBORAH A (FNP)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:WASSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:A
Other - Last Name:LYDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PIMC-PNC PO BOX 31001-0698
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91110-0698
Mailing Address - Country:US
Mailing Address - Phone:602-263-1200
Mailing Address - Fax:
Practice Address - Street 1:YAVAPAI-APACHE HEALTH CENTER
Practice Address - Street 2:2121 W RESERVATION LOOP RD
Practice Address - City:CAMP VERDE
Practice Address - State:AZ
Practice Address - Zip Code:86322-8412
Practice Address - Country:US
Practice Address - Phone:928-567-2168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7345363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS64274Medicare UPIN