Provider Demographics
NPI:1699156539
Name:DE VERA, MARY ANN Z (FNP)
Entity type:Individual
Prefix:MRS
First Name:MARY ANN
Middle Name:Z
Last Name:DE VERA
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 1:3894 SPRINGFIELD CMN
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-2251
Mailing Address - Country:US
Mailing Address - Phone:510-265-4005
Mailing Address - Fax:
Practice Address - Street 1:2147 MOWRY AVE STE D4
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1724
Practice Address - Country:US
Practice Address - Phone:510-574-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95002546363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily