Provider Demographics
NPI:1023580446
Name:MAZZETTO, DEIRDRE ALICE (NP, AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:ALICE
Last Name:MAZZETTO
Suffix:
Gender:F
Credentials:NP, AGACNP-BC
Other - Prefix:
Other - First Name:DEIRDRE
Other - Middle Name:ALICE
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP, AGACNP-BC
Mailing Address - Street 1:220 E 13TH ST
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95341-6250
Mailing Address - Country:US
Mailing Address - Phone:209-723-2122
Mailing Address - Fax:
Practice Address - Street 1:220 E 13TH ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95341-6250
Practice Address - Country:US
Practice Address - Phone:209-723-2122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-24
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010718363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care