MEDICARE: MS. COLLEEN ANN DEBOER ANP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	F302302-1	NY

General Provider Information

NPI Number	:	1902953904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. COLLEEN ANN DEBOER ANP

Provider Business Mailing Address
First Line	:	1 GUSTAVE L LEVY PL
Second Line	:	MOUNT SINAI MEDICAL CENTER, BOX 1128
City	:	NEW YORK
State	:	NY
Zip	:	10029-6500
Country	:	US
Telephone Number	:	212-659-5649
Fax Number	:	212-659-5599

Provider Business Practice Location Address
First Line	:	1 GUSTAVE L LEVY PL
Second Line	:	MOUNT SINAI MEDICAL CENTER, BOX 1128
City	:	NEW YORK
State	:	NY
Zip	:	10029-6500
Country	:	US
Telephone Number	:	212-659-5649
Fax Number	:	212-659-5599

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	05/19/2011

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