Provider Demographics
NPI:1609843051
Name:BOARDMAN-CHEEVERS, DEBRA (FNP)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:
Last Name:BOARDMAN-CHEEVERS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 45680
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94145-0680
Mailing Address - Country:US
Mailing Address - Phone:530-333-2548
Mailing Address - Fax:530-333-2832
Practice Address - Street 1:6065 HIGHWAY 193
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:CA
Practice Address - Zip Code:95634-9623
Practice Address - Country:US
Practice Address - Phone:530-333-2548
Practice Address - Fax:530-333-2832
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200450019NP363L00000X
CA314676363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR134454Medicare PIN
ORR134455Medicare PIN
ORR134453Medicare PIN
TNQ11861Medicare UPIN