Provider Demographics
NPI:1619252509
Name:FASSETT, JOHN ALBERT (RNP/CNM)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ALBERT
Last Name:FASSETT
Suffix:
Gender:M
Credentials:RNP/CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3625 CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1701
Mailing Address - Country:US
Mailing Address - Phone:415-668-1010
Mailing Address - Fax:415-668-7465
Practice Address - Street 1:3625 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1701
Practice Address - Country:US
Practice Address - Phone:415-668-1010
Practice Address - Fax:415-668-7465
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CANMW1037367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife