Provider Demographics
NPI:1497969422
Name:MCFADDEN, DEANNA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:MCFADDEN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11065 FOOTHILL RD
Mailing Address - Street 2:
Mailing Address - City:SANTA PAULA
Mailing Address - State:CA
Mailing Address - Zip Code:93060-9742
Mailing Address - Country:US
Mailing Address - Phone:805-647-6612
Mailing Address - Fax:
Practice Address - Street 1:4000 S ROSE AVE
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033-6683
Practice Address - Country:US
Practice Address - Phone:805-678-5832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF8558363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1497969422OtherHEALTH CENTER
1497969422OtherHEALTH CENTER