Provider Demographics
NPI:1194011072
Name:DEBOER, NICOLE ALEXCINE
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:ALEXCINE
Last Name:DEBOER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 S. MAIN STREET
Mailing Address - Street 2:UNITED MEDICAL CENTERS
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840
Mailing Address - Country:US
Mailing Address - Phone:830-774-5534
Mailing Address - Fax:830-775-7325
Practice Address - Street 1:913 S. MAIN ST.
Practice Address - Street 2:UNITED MEDICAL CENTERS
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840
Practice Address - Country:US
Practice Address - Phone:830-774-4363
Practice Address - Fax:830-775-7325
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant