Provider Demographics
NPI:1245429083
Name:NICHOLSON, DEBRA E (RN)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:E
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3024 NW LAWRENCE CT
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-5649
Mailing Address - Country:US
Mailing Address - Phone:541-385-3195
Mailing Address - Fax:866-575-1208
Practice Address - Street 1:3024 NW LAWRENCE CT
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-5649
Practice Address - Country:US
Practice Address - Phone:541-385-3195
Practice Address - Fax:866-575-1208
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health