Healthcare Provider Details

I. General information

NPI: 1811534191
Provider Name (Legal Business Name): JOSEPH DEBBAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2019
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1803 PAPIO LN
COZAD NE
69130-1138
US

IV. Provider business mailing address

1803 PAPIO LN
COZAD NE
69130-1138
US

V. Phone/Fax

Practice location:
  • Phone: 308-784-3535
  • Fax:
Mailing address:
  • Phone: 308-784-3535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WF0300X
TaxonomyFlight Registered Nurse
License Number62536
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number113067
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: