Provider Demographics
NPI:1962425389
Name:NICHOLS, DEBORAH ANN (FNP)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:ANN
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:200 W FRONTIER ST
Mailing Address - Street 2:SUITE M
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541-5362
Mailing Address - Country:US
Mailing Address - Phone:928-595-1176
Mailing Address - Fax:928-478-6206
Practice Address - Street 1:200 W FRONTIER ST
Practice Address - Street 2:SUITE M
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-5362
Practice Address - Country:US
Practice Address - Phone:928-478-6280
Practice Address - Fax:928-478-6206
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN078398363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P62785Medicare UPIN