Elizabeth Dederick, Nursing, PC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

ELIZABETH DEDERICK, NURSING, PC

Practice address

60547 Stagemans Rd
Landers, CA 92285-9402

Phone

(760) 861-0368

Fax

(760) 273-0921

NPI assigned

Mar 15, 2024

Last updated

Nov 21, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Elizabeth Anne Dederick, FNPNPI 1619602570

Title

Ceo

Phone

(760) 910-1112

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Elizabeth Anne Dederick, NP

  • Family Nurse Practitioner
  • Victorville, CA
  • NPI 1619602570
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1710460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732147200000",
    "number": "1982463584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3952",
            "city": "LANDERS",
            "state": "CA",
            "postal_code": "922850952",
            "telephone_number": "760-910-1112",
            "fax_number": "760-273-0921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60547 STAGEMANS RD",
            "city": "LANDERS",
            "state": "CA",
            "postal_code": "922859402",
            "telephone_number": "760-861-0368",
            "fax_number": "760-273-0921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELIZABETH DEDERICK, NURSING, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-15",
        "last_updated": "2024-11-21",
        "certification_date": "2024-11-21",
        "status": "A",
        "authorized_official_last_name": "DEDERICK",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "760-910-1112",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher Avitabile, MFT
• Jeff W Eamer
• Kaern Kreyling, MFT
• Melissa Launder
• Grecia Toledo Jaimes

• Family Nurse Practitioner in Landers, CA
• Providers in Landers, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.