Provider Demographics
NPI:1821016015
Name:HILL, DEBORAH (PNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:HILL
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3412 S 25TH E
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-4967
Mailing Address - Country:US
Mailing Address - Phone:208-497-0680
Mailing Address - Fax:208-497-0650
Practice Address - Street 1:3412 S 25TH E
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-4967
Practice Address - Country:US
Practice Address - Phone:208-497-0680
Practice Address - Fax:208-497-0650
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT218644-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner