Provider Demographics
NPI:1902493117
Name:POWER, DEIRDRE GRACE (NURSE PRACTITITONER)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:GRACE
Last Name:POWER
Suffix:
Gender:F
Credentials:NURSE PRACTITITONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13762 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-3832
Mailing Address - Country:US
Mailing Address - Phone:510-918-3428
Mailing Address - Fax:510-969-8182
Practice Address - Street 1:13762 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-3832
Practice Address - Country:US
Practice Address - Phone:510-918-3428
Practice Address - Fax:510-969-8182
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95015025363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care