Provider Demographics
NPI:1396989083
Name:DEBOUNO, JAMIE ANN (NP-C)
Entity type:Individual
Prefix:MISS
First Name:JAMIE ANN
Middle Name:
Last Name:DEBOUNO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:JAMIE ANN
Other - Middle Name:
Other - Last Name:DEBOUNO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP-C, RN
Mailing Address - Street 1:151 FRIES MILL RD
Mailing Address - Street 2:STE 202
Mailing Address - City:BLACKWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-2057
Mailing Address - Country:US
Mailing Address - Phone:855-727-2465
Mailing Address - Fax:
Practice Address - Street 1:1907 NEW RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1545
Practice Address - Country:US
Practice Address - Phone:609-645-8884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-24
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR129390000163W00000X
PARN575581163W00000X
PASP010169363LA2200X
PASP011146363LF0000X
NJ26NJ00185000363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily