Healthcare Provider Details

I. General information

NPI: 1649558974
Provider Name (Legal Business Name): JUDY ANN DEBOER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2011
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14020 HWY 13 S STE 350
SAVAGE MN
55378-7103
US

IV. Provider business mailing address

508 NE 83RD ST
VANCOUVER WA
98665-8121
US

V. Phone/Fax

Practice location:
  • Phone: 952-395-2500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60569994
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNUR-APRN-LIC-174311
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number170192
License Number StateAK
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201910857NP-PP
License Number StateOR
# 5
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12673
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: