Provider Demographics
NPI:1316624299
Name:DEBONEE, AMANDA MAE
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MAE
Last Name:DEBONEE
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 1:75 STATION LNDG UNIT 323
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-5241
Mailing Address - Country:US
Mailing Address - Phone:617-955-6672
Mailing Address - Fax:
Practice Address - Street 1:300 BOYLSTON ST
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-1959
Practice Address - Country:US
Practice Address - Phone:617-955-6672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2343060163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0200XNursing Service ProvidersRegistered NurseOncology