Provider Demographics
NPI:1528122165
Name:DEBAUCHE, DEBORAH LYNN (PA-C)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LYNN
Last Name:DEBAUCHE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12150 NORTHCLIFF RD
Mailing Address - Street 2:
Mailing Address - City:ELBERT
Mailing Address - State:CO
Mailing Address - Zip Code:80106-8867
Mailing Address - Country:US
Mailing Address - Phone:719-495-0060
Mailing Address - Fax:719-494-2045
Practice Address - Street 1:6465 GREENWOOD PLAZA BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-4905
Practice Address - Country:US
Practice Address - Phone:888-795-7975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO592363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical