Provider Demographics
NPI:1518501097
Name:DEBOER, DENA KAE
Entity Type:Individual
Prefix:
First Name:DENA
Middle Name:KAE
Last Name:DEBOER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25211 S 68TH ST
Mailing Address - Street 2:
Mailing Address - City:FIRTH
Mailing Address - State:NE
Mailing Address - Zip Code:68358-7598
Mailing Address - Country:US
Mailing Address - Phone:402-791-0020
Mailing Address - Fax:
Practice Address - Street 1:25211 S 68TH ST
Practice Address - Street 2:
Practice Address - City:FIRTH
Practice Address - State:NE
Practice Address - Zip Code:68358-7598
Practice Address - Country:US
Practice Address - Phone:402-791-0020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE42541163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE42541Medicaid