Provider Demographics
NPI:1629040969
Name:NIGBUR, DEBRA A (PA-C)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:A
Last Name:NIGBUR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:A
Other - Last Name:WALCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:6470 S HIGLEY RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-4341
Mailing Address - Country:US
Mailing Address - Phone:480-809-2409
Mailing Address - Fax:
Practice Address - Street 1:6470 S HIGLEY RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85298-4341
Practice Address - Country:US
Practice Address - Phone:480-809-2409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5732363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP00888757OtherRAILROAD MEDICARE
MN532740700Medicaid
MN970003318Medicare PIN
MNP00888757OtherRAILROAD MEDICARE
MN532740700Medicaid
MN970000050Medicare PIN