Provider Demographics
NPI:1891521514
Name:DOMBOVY, DEBRA JOAN (BSN RN)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:JOAN
Last Name:DOMBOVY
Suffix:
Gender:F
Credentials:BSN RN
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:JOAN
Other - Last Name:HANSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BSN RN
Mailing Address - Street 1:3925 W TONOPAH DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-4756
Mailing Address - Country:US
Mailing Address - Phone:623-628-1591
Mailing Address - Fax:
Practice Address - Street 1:8624 W SWEETWATER AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-8101
Practice Address - Country:US
Practice Address - Phone:623-412-4853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN122312163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WS0200XNursing Service ProvidersRegistered NurseSchoolGroup - Single Specialty