Healthcare Provider Details

I. General information

NPI: 1093625220
Provider Name (Legal Business Name): DEBORA NYACHAE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 DEMERS AVE STE 200
GRAND FORKS ND
58201-4573
US

IV. Provider business mailing address

4314 QUAIL FIELD DR
ARLINGTON TX
76001-7636
US

V. Phone/Fax

Practice location:
  • Phone: 469-856-0212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1123919
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: