Provider Demographics
NPI:1982186953
Name:DEBACA, CHRISTINA NICHOLE (BSN, RN)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:NICHOLE
Last Name:DEBACA
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 SWEETWATER AVE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:NE
Mailing Address - Zip Code:69301-2672
Mailing Address - Country:US
Mailing Address - Phone:308-762-5475
Mailing Address - Fax:308-762-8249
Practice Address - Street 1:1604 SWEETWATER AVE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NE
Practice Address - Zip Code:69301-2672
Practice Address - Country:US
Practice Address - Phone:308-762-5475
Practice Address - Fax:308-762-8249
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE67832163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool