Provider Demographics
NPI:1235471244
Name:DEBETTENCOURT, NICOLE MARIE (DNP)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:MARIE
Last Name:DEBETTENCOURT
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 MEDICAL PKWY STE 670
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3277
Mailing Address - Country:US
Mailing Address - Phone:443-481-1150
Mailing Address - Fax:410-224-0065
Practice Address - Street 1:2002 MEDICAL PKWY STE 670
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3277
Practice Address - Country:US
Practice Address - Phone:443-481-1150
Practice Address - Fax:410-224-0065
Is Sole Proprietor?:No
Enumeration Date:2013-03-18
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR208916363LA2200X, 363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MK3220857OtherDEA