Healthcare Provider Details

I. General information

NPI: 1962425389
Provider Name (Legal Business Name): DEBORAH ANN NICHOLS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 02/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W FRONTIER ST SUITE M
PAYSON AZ
85541-5362
US

IV. Provider business mailing address

200 W FRONTIER ST SUITE M
PAYSON AZ
85541-5362
US

V. Phone/Fax

Practice location:
  • Phone: 928-478-6280
  • Fax: 928-478-6206
Mailing address:
  • Phone: 928-595-1176
  • Fax: 928-478-6206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN078398
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: