Provider Demographics
NPI:1164504668
Name:GASSETT, REBECCA DIANE (RN, MS, CPNP)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:DIANE
Last Name:GASSETT
Suffix:
Gender:F
Credentials:RN, MS, CPNP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:DIANE
Other - Last Name:COONER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:HEALTHY ENDEAVORS
Mailing Address - Street 1:550 W BASELINE RD STE 102183
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-6031
Mailing Address - Country:US
Mailing Address - Phone:602-688-4191
Mailing Address - Fax:480-780-0665
Practice Address - Street 1:550 W BASELINE RD STE 102183
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-6031
Practice Address - Country:US
Practice Address - Phone:602-688-4191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010004363L00000X
AZAP8597363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner