Provider Demographics
NPI:1104312172
Name:NETHERCUTT, DEBORAH CAROL (NP-C)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:CAROL
Last Name:NETHERCUTT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 W BEARDSLEY AVE
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-1825
Mailing Address - Country:US
Mailing Address - Phone:574-206-4156
Mailing Address - Fax:
Practice Address - Street 1:1621 W BEARDSLEY AVE
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-1825
Practice Address - Country:US
Practice Address - Phone:574-206-4156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71008316A363LF0000X
IN28137048A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300018480Medicaid