Healthcare Provider Details

I. General information

NPI: 1609843051
Provider Name (Legal Business Name): DEBRA BOARDMAN-CHEEVERS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 11/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6065 HIGHWAY 193
GEORGETOWN CA
95634-9623
US

IV. Provider business mailing address

PO BOX 45680
SAN FRANCISCO CA
94145-0680
US

V. Phone/Fax

Practice location:
  • Phone: 530-333-2548
  • Fax: 530-333-2832
Mailing address:
  • Phone: 530-333-2548
  • Fax: 530-333-2832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number200450019NP
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number314676
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: