Provider Demographics
NPI:1922033588
Name:GWERDER, DEBRA D (FNP, PMHNP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:D
Last Name:GWERDER
Suffix:
Gender:F
Credentials:FNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2733 N POWER RD STE 102-220
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-1758
Mailing Address - Country:US
Mailing Address - Phone:480-364-5149
Mailing Address - Fax:480-900-8476
Practice Address - Street 1:2733 N POWER RD STE 102-220
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215-1758
Practice Address - Country:US
Practice Address - Phone:480-364-5149
Practice Address - Fax:480-900-8476
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP0700363LP0808X
AZ046515363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ548331Medicaid
AZZ134317Medicare PIN
AZP29764Medicare UPIN