Provider Demographics
NPI:1578163515
Name:BASSETTE, DEANNA (APRN, FNP)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:BASSETTE
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 E 31ST ST APT 401
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-5212
Mailing Address - Country:US
Mailing Address - Phone:708-466-9317
Mailing Address - Fax:
Practice Address - Street 1:243 E 31ST ST APT 401
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-5212
Practice Address - Country:US
Practice Address - Phone:708-466-9317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209022330363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily