Healthcare Provider Details

I. General information

NPI: 1508181959
Provider Name (Legal Business Name): DEBRA ANNE BUGBEE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2010
Last Update Date: 03/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 FOWLER WAY SUITE 4
PLACERVILLE CA
95667-5746
US

IV. Provider business mailing address

PO BOX 45680
SAN FRANCISCO CA
94145-0680
US

V. Phone/Fax

Practice location:
  • Phone: 530-626-9488
  • Fax: 530-626-1104
Mailing address:
  • Phone: 530-626-9488
  • Fax: 530-626-1104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberNP5541
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: