Healthcare Provider Details

I. General information

NPI: 1861191702
Provider Name (Legal Business Name): NICOLE DEBOER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2023
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 NE NEFF RD STE 302
BEND OR
97701-4279
US

IV. Provider business mailing address

12040 NE 128TH ST
KIRKLAND WA
98034-3013
US

V. Phone/Fax

Practice location:
  • Phone: 541-706-6915
  • Fax: 541-706-6733
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61478766
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN61095221
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: