Healthcare Provider Details

I. General information

NPI: 1225707953
Provider Name (Legal Business Name): DEBRA KAY DEGROOT APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 S HERITAGE WOODS DR
APPLETON WI
54915-1408
US

IV. Provider business mailing address

2297 SKYVIEW ST
GREEN BAY WI
54311-6000
US

V. Phone/Fax

Practice location:
  • Phone: 920-225-7875
  • Fax: 920-993-5003
Mailing address:
  • Phone: 920-366-2458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10881-33
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number10881
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number10881
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: