=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497969422
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEANNA MCFADDEN NURSE PRACTITIONER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2007
-----------------------------------------------------
Last Update Date | 11/18/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4000 S ROSE AVE
-----------------------------------------------------
City | OXNARD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93033-6683
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-678-5832
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11065 FOOTHILL RD
-----------------------------------------------------
City | SANTA PAULA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93060-9742
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-647-6612
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | NPF8558
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------