Provider Demographics
NPI:1346514593
Name:ZOZO, DENEAN (WHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:DENEAN
Middle Name:
Last Name:ZOZO
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:MISS
Other - First Name:DENEAN
Other - Middle Name:
Other - Last Name:WALLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WHNP-BC
Mailing Address - Street 1:52D MEDICAL GROUP
Mailing Address - Street 2:UNIT 3690
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09126-3690
Mailing Address - Country:US
Mailing Address - Phone:314-452-3184
Mailing Address - Fax:
Practice Address - Street 1:52D MEDICAL GROUP
Practice Address - Street 2:UNIT 3690
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09126-3690
Practice Address - Country:US
Practice Address - Phone:314-452-3184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-06
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN184447163W00000X, 363LX0001X
TN104373819363LW0102X
TN17274363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No163W00000XNursing Service ProvidersRegistered Nurse
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1346514593Medicaid