Healthcare Provider Details

I. General information

NPI: 1396989083
Provider Name (Legal Business Name): JAMIE ANN DEBOUNO NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMIE ANN DEBOUNO NP-C, RN

II. Dates (important events)

Enumeration Date: 04/24/2009
Last Update Date: 12/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 NEW RD
NORTHFIELD NJ
08225-1545
US

IV. Provider business mailing address

151 FRIES MILL RD STE 202
BLACKWOOD NJ
08012-2057
US

V. Phone/Fax

Practice location:
  • Phone: 609-645-8884
  • Fax:
Mailing address:
  • Phone: 855-727-2465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR129390000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN575581
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP010169
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP011146
License Number StatePA
# 5
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ00185000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: