Healthcare Provider Details

I. General information

NPI: 1629040969
Provider Name (Legal Business Name): DEBRA A NIGBUR PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBRA A WALCOTT PA-C

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 11/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6470 S HIGLEY RD
GILBERT AZ
85298-4341
US

IV. Provider business mailing address

6470 S HIGLEY RD
GILBERT AZ
85298-4341
US

V. Phone/Fax

Practice location:
  • Phone: 480-809-2409
  • Fax:
Mailing address:
  • Phone: 480-809-2409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5732
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5732
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: