Provider Demographics
NPI:1275265605
Name:DEMINT, DEBRA S (RN, VRC)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:S
Last Name:DEMINT
Suffix:
Gender:F
Credentials:RN, VRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3243 S TERRA DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-3833
Mailing Address - Country:US
Mailing Address - Phone:208-340-3411
Mailing Address - Fax:
Practice Address - Street 1:3243 S TERRA DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-3833
Practice Address - Country:US
Practice Address - Phone:208-340-3411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID23402163W00000X, 163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID23402OtherIDAHO STATE BOARD OF NURSING