Healthcare Provider Details

I. General information

NPI: 1457063190
Provider Name (Legal Business Name): AUDREY E DEBOO BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2022
Last Update Date: 12/14/2022
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 OVERLOOK TER
MADISON WI
53705-2254
US

IV. Provider business mailing address

86 COUNTY RD N
EDGERTON WI
53534-9559
US

V. Phone/Fax

Practice location:
  • Phone: 608-280-7002
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number201606498RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: