Healthcare Provider Details

I. General information

NPI: 1982186953
Provider Name (Legal Business Name): CHRISTINA NICHOLE DEBACA BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2018
Last Update Date: 09/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 SWEETWATER AVE
ALLIANCE NE
69301-2672
US

IV. Provider business mailing address

1604 SWEETWATER AVE
ALLIANCE NE
69301-2672
US

V. Phone/Fax

Practice location:
  • Phone: 308-762-5475
  • Fax: 308-762-8249
Mailing address:
  • Phone: 308-762-5475
  • Fax: 308-762-8249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number67832
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: