Provider Demographics
NPI:1851159008
Name:WASSON, CAILA MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:CAILA
Middle Name:MARIE
Last Name:WASSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3509 COFFEE RD STE D3
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-1357
Mailing Address - Country:US
Mailing Address - Phone:844-227-7599
Mailing Address - Fax:855-903-5155
Practice Address - Street 1:3509 COFFEE RD STE D3
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-1357
Practice Address - Country:US
Practice Address - Phone:844-227-7599
Practice Address - Fax:855-903-5155
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028697363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily